Does a tertiary Gleason pattern 4 or 5 influence the risk of biochemical relapse after radical prostatectomy for clinically localized prostate cancer?
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Objective. The presence of a tertiary Gleason grade (TGG) pattern 4 or 5 in radical prostatectomy (RP) specimens has been reported with adverse pathology and a higher biochemical relapse rate after RP. This study investigated the impact of a TGG pattern 4 or 5 on biochemical and pathological outcome in men operated with RP. Material and methods. The study reviewed 151 consecutive cases treated at the hospital between 1985 and 2006; 148 were included in the study. All prostatectomy specimens were re-examined by a genitourinary pathologist and among others parameters the presence of TGG pattern 4 or 5 was recorded. The hospital files were examined retrospectively for clinical follow-up data. Prostate-specific antigen (PSA) relapse was defined as two subsequent rising measurements above 0.20 ng/ml. The influence of a TGG pattern 4 or 5 on prognosis was assessed in a Cox proportional hazards regression model controlling for pathological stage, surgical margin (SM) status, seminal vesicle invasion (SVI) and extraprostatic extension (EPE). Results. Fifty-six patients (38%) experienced PSA relapse during follow-up. Twenty-one patients (58%) with a TGG pattern 4 or 5 had a biochemical relapse compared with 35 patients (31%) without TGG pattern 4 or 5. In the Cox regression model, TGG pattern 4 or 5 was an independent predictor of biochemical failure (p = 0.020). Conclusions. In patients undergoing RP the presence of a TGG pattern 4 or 5 is an independent predictor for biochemical relapse. Consequently, the RP specimens should routinely be investigated for TGG pattern 4 or 5.Keywords:
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Background and Objective To examine the association between the features of metabolic syndrome (MetS) (obesity, hypertension, diabetes mellitus, and dyslipidemia) and the risk of biochemical recurrence (BCR) after radical prostatectomy in patients with prostate cancer. Methods This study included 283 Japanese patients with localized prostate cancer who were treated with radical prostatectomy between 2008 and 2012. Their oncological outcomes and the prognostic significance of several clinicopathological factors, as well as the features of MetS, were analyzed. Results Of 283 men who underwent radical prostatectomy, 49 (17.2%) subsequently developed BCR with a median postoperative follow-up of 14.8 months. Among the clinicopathological factors, prostate-specific antigen (PSA) level at diagnosis, pathological stage, pathological Gleason score, and lymph-node involvement were independent risk factors for BCR in multivariate analysis. In addition, the number of metabolic risk factors was also an independent risk factor for BCR. Conclusions The features of MetS were linked with poorer outcome after radical prostatectomy among Japanese men. Further investigations are needed to determine the effect of improving MetS on prostate cancer prognosis. J. Surg. Oncol. 2014; 110:476–481. © 2014 Wiley Periodicals, Inc.
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PURPOSE: The PSA recurrence develops in 27 to 53% within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeon's expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. MATERIALS AND METHODS: A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of > 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. RESULTS: Biochemical recurrence was detected in 23.5% (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03). The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). CONCLUSION: The PSA recurrence was detected in 21.6% of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.
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You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2017PD07-09 PROSTATE SPECIFIC ANTIGEN TESTING AFTER RADICAL PROSTATECTOMY: CAN WE STOP AT 20 YEARS? Wesley Ludwig, Zhaoyong Feng, Bruce Trock, Elizabeth Humphreys, and Patrick Walsh Wesley LudwigWesley Ludwig More articles by this author , Zhaoyong FengZhaoyong Feng More articles by this author , Bruce TrockBruce Trock More articles by this author , Elizabeth HumphreysElizabeth Humphreys More articles by this author , and Patrick WalshPatrick Walsh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.384AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While our understanding of early and intermediate biochemical recurrence is robust, the time-course and clinical features of delayed biochemical recurrence are less well defined. We examined the clinical features and outcomes associated with delayed biochemical recurrence after radical prostatectomy, specifically amongst men with over 20 years of follow-up. METHODS 16,720 men underwent radical prostatectomy and 2,699 experienced biochemical recurrence. We determined predictors of delayed biochemical recurrence as well as metastasis-free survival and cancer specific survival rates for recurrence at various time points after radical prostatectomy. We performed a subset analysis of the 732 men with 20 or more years of recurrence free follow-up. Actuarial metastasis-free and cancer specific survival was calculated to determine the actuarial probability of biochemical recurrence at 30 years after radical prostatectomy. RESULTS The majority of biochemical recurrence occurred within five years of radical prostatectomy, and decreased with each five-year period. Delayed biochemical recurrence was associated with favorable metastasis-free survival and cancer specific survival compared to early biochemical recurrence (Figure). Amongst the 732 men with an undetectable prostate specific antigen at 20 years, 17 (2.3%) developed a biochemical recurrence, a single patient developed metastatic disease, and none died due to prostate cancer. The actuarial probability of biochemical recurrence amongst men with an undetectable prostate specific antigen at 20 years increased with adverse pathologic features. CONCLUSIONS Men with delayed biochemical recurrence have favorable clinical features and improved survival. Men with an undetectable prostate specific antigen 20 years after radical prostatectomy had a very low rate of recurrence and no deaths due to prostate cancer. This suggests that 20 years is a reasonable time point to discontinue PSA testing. Figure. Kaplan-Meier curves for actuarial (a) metastasis-free survival and (b) cancer-specific survival, stratified by the timing of biochemical recurrence (4 groups). © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e131 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Wesley Ludwig More articles by this author Zhaoyong Feng More articles by this author Bruce Trock More articles by this author Elizabeth Humphreys More articles by this author Patrick Walsh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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To identify risk factors of biochemical recurrence after radical prostatectomy in high-risk patients.A total of 191 high-risk prostate cancer patients according to the D'Amico classification treated with radical prostatectomy at a single institution between April 2000 and December 2013 were enrolled. The pathological evaluation including intraductal carcinoma of prostate was reassessed, and the clinical and pathological risk factors of biochemical recurrence were analyzed.The median follow up after radical prostatectomy was 49 months. The 5-year biochemical recurrence-free survival rate after radical prostatectomy in high-risk prostate cancer patients was 41.6%. Initial prostate-specific antigen, pathological Gleason score, seminal vesicle invasion, extraprostatic extension and intraductal carcinoma of the prostate were significantly associated with biochemical recurrence-free survival. The 5-year biochemical recurrence-free survival rates in patients with zero, one, two and three of these risk factors were 92.9%, 70.7%, 38.3% and 28.8%, respectively. In patients with four or more factors, the biochemical recurrence-free survival rate was 6.1% after 18 months.In D'Amico high-risk patients treated with radical prostatectomy, risk factors for biochemical recurrence can be identified. Patients with fewer risk factors have longer biochemical recurrence-free survival, even among these high-risk cases.
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We evaluated clinical outcomes of radical prostatectomy in 244 patients who had undergone radical prostatectomy as initial treatment from January 2000 to December 2011, and were followed up for more than 6 months. Biochemical recurrence after prostatectomy was defined as prostate-specific antigen (PSA) level of at least 0. 2 ng/ml. We evaluated potential risk factors for significant associations with biochemical recurrence. Median follow-up period after prostatectomy was 49 months (range, 6-144). Of the total, 192, 31, and 20 patients were at pathological stage pT2, pT3a, and pT3b, respectively. In 83 patients with the positive surgical margin, apexes were mostly in the positive area. Of the 68 patients with PSA recurrence, PSA non-relapse rate was 66.6% for 5 years. Multivariate analysis was performed for seminal vesicle invasion, PSA nadir, surgical margins, and Gleason score. Thirty-two patients with PSA recurrence underwent salvage radiotherapy, and the biochemical recurrence rate at 5 years was 73.8%. The group in which the PSA level before salvage radiotherapy was ＜0.5 ng/ml had a low rate of biochemical recurrence. We must consider the recurrence of poorly differentiated or non-confined cancer after radical prostatectomy. These results suggest that early use of salvage radiotherapy is effective for patients with biochemical recurrence after radical prostatectomy.
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The objective of this study was to determine whether the presence of perineural invasion (PNI) in radical prostatectomy specimens could be a useful prognostic parameter in Japanese men with prostate cancer. Between January 1995 and September 2003, 202 Japanese men underwent radical retropubic prostatectomy for prostate cancer without any neoadjuvant therapies prior to surgery. We retrospectively analyzed the relationship between PNI in radical prostatectomy specimens and other prognostic factors, and also assessed the significance of PNI in biochemical recurrence after radical prostatectomy. The presence of PNI was significantly related to clinical stage, pathological stage, Gleason score, seminal vesicle invasion, lymph node metastasis and tumor volume, but not pretreatment serum prostate specific antigen value. During the observation period, biochemical recurrence occurred in 20 patients (3 in patients without PNI and 17 in those with PNI), and the biochemical recurrence-free survival rate in patients with PNI was significantly lower than that in patients without PNI. In addition to-PNI, pathological stage, seminal vesicle invasion, lymph node metastasis and tumor volume were significantly associated with the biochemical recurrence-free survival rate; however, among these five factors, only seminal vesicle invasion was an independent predictor of biochemical recurrence on multivariate analysis. Despite a significant association between several prognostic parameters, PNI was not an independent predictor of biochemical recurrence; therefore, it may not provide an additive effect to consider the presence of PNI in predicting the prognosis of Japanese men who underwent radical prostatectomy if there are other conventional parameters available.
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Introduction: Prostate cancer is the most commonly diagnosed cancer in men. Radical prostatectomy is a potentially curative alternative for localized disease, although a significant percentage of these patients will suffer a biochemical recurrence with associated mortality. A wide spectrum of anticancer properties of statins has been demonstrated and the role of these drugs in prevention and treatment of other types of cancer is being increasingly studied. Objective: The aim of this study was to investigate whether the use of statins is associated with reduced risk of biochemical recurrence among patients submitted to radical prostatectomy. Patients and Methods: We retrospectively reviewed 875 patients submitted to radical prostatectomy between January 2009 and December 2018. Approximately 45.7% of the patients were on medication with statins at the time of surgery. We evaluated a possible association between statin use and biochemical recurrence and which patients would benefit the most with statin treatment. Results: Overall, statins were associated with an approximately 40% reduction in risk of biochemical recurrence at a median follow-up time of 51.2 months (HR 0.599, p < 0.05). Patients with pT2c staging (HR 0.486, p =0.017) and ISUP ≥ 3 (HR 0.61, p =0.011) seem to have benefited more from statin use. Conclusion: In this cohort, use of statins proved beneficial in reducing the risk of biochemical recurrence among patients submitted to radical prostatectomy. Prospective studies are required to confirm this result and to evaluate its safety profile in those patients. Keywords: prevention, prostate cancer, radical prostatectomy, recurrence, statins
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Background Radical prostatectomy (RP) has been used as the main primary treatment for prostate cancer (PCa) for many years with excellent oncologic results. However, approximately 20-40% of those patients has failed to RP and presented biochemical recurrence (BCR). Prostatic specific antigen (PSA) has been the pivotal tool for recurrence diagnosis, but there is no consensus about the best PSA threshold to define BCR until this moment. The natural history of BCR after surgical procedure is highly variable, but it is important to distinguish biochemical and clinical recurrence and to find the correct timing to start multimodal treatment strategy. Also, it is important to understand the role of each clinical and pathological feature of prostate cancer in BCR, progression to metastatic disease and cancer specific mortality (CSM). Review design A simple review was made in Medline for articles written in English language about biochemical recurrence after radical prostatectomy. Objective To provide an updated assessment of BCR definition, its meaning, PCa natural history after BCR and the weight of each clinical/pathological feature and risk group classifications in BCR, metastatic disease and CSM.
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No AccessJournal of UrologyAdult Urology1 Jul 2009Length of Positive Surgical Margin After Radical Prostatectomy as a Predictor of Biochemical Recurrenceis accompanied byPhase II Trial of Capecitabine and Weekly Docetaxel for Metastatic Castrate Resistant Prostate Cancer Sergey Shikanov, Jie Song, Cassandra Royce, Hikmat Al-Ahmadie, Kevin Zorn, Gary Steinberg, Gregory Zagaja, Arieh Shalhav, and Scott Eggener Sergey ShikanovSergey Shikanov , Jie SongJie Song , Cassandra RoyceCassandra Royce , Hikmat Al-AhmadieHikmat Al-Ahmadie , Kevin ZornKevin Zorn , Gary SteinbergGary Steinberg , Gregory ZagajaGregory Zagaja , Arieh ShalhavArieh Shalhav , and Scott EggenerScott Eggener View All Author Informationhttps://doi.org/10.1016/j.juro.2009.02.139AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Length and location of positive surgical margins are independent predictors of biochemical recurrence after open radical prostatectomy. We assessed their impact on biochemical recurrence in a large robotic prostatectomy series. Materials and Methods: Data were collected prospectively from 1,398 men undergoing robotic radical prostatectomy for clinically localized prostate cancer from 2003 to 2008 at a single institution. The associations of preoperative prostate specific antigen, pathological Gleason score, pathological stage and positive surgical margin parameters (location, length and focality) with biochemical recurrence rate were evaluated. Margin status and length were measured by a single uropathologist. Biochemical recurrence was defined as serum prostate specific antigen greater than 0.1 ng/ml on 2 consecutive tests. Cox regression models were constructed to evaluate predictors of biochemical recurrence. Results: Of 1,398 consecutive patients who underwent robotic prostatectomy positive margins were present in 243 (17%) (11% of pathological T2 and 41% of T3). Preoperative prostate specific antigen, pathological stage, Gleason score, margin status, and margin length as a continuous and categorical variable (less than 1, 1 to 3, more than 3 mm) were independent predictors of biochemical recurrence. Patients with negative margins and those with a positive margin less than 1 mm had similar rates of biochemical recurrence (log rank test p = 0.18). Surgical margin location was not independently associated with biochemical recurrence. Conclusions: Margin status and length are independent predictors of biochemical recurrence following robotic radical prostatectomy. Although longer followup and validation studies are necessary for confirmation, patients with a positive margin less than 1 mm appear to have similar recurrence rates as those with negative margins. References 1 : Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. Urology1997; 50: 733. Crossref, Medline, Google Scholar 2 : Prognostic significance of location of positive margins in radical prostatectomy specimens. Urology2007; 70: 965. Google Scholar 3 : Natural history of biochemical progression after radical prostatectomy based on length of a positive margin. Urology2008; 71: 308. Google Scholar 4 : Do margins matter?: The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol2008; 179: S47. Link, Google Scholar 5 : Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol2007; 51: 648. Google Scholar 6 : Robotic radical prostatectomy: outcomes of 500 cases. BJU Int2007; 99: 1109. Google Scholar 7 : A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol2007; 178: 2385. Link, Google Scholar 8 : Adoption of new technology and healthcare quality: surgical margins after robotic prostatectomy. Urology2007; 70: 96. Google Scholar 9 : Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur Urol2007; 51: 755. Google Scholar 10 : Complete histologic serial sectioning of a prostate gland with adenocarcinoma. Am J Surg Pathol1993; 17: 468. Google Scholar 11 : Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol2007; 51: 45. Google Scholar 12 : Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol2008; 55: 87. Google Scholar 13 : Positive proximal (bladder neck) margin at radical prostatectomy confers greater risk of biochemical progression. Urology2004; 64: 551. Google Scholar 14 : Positive surgical margins with radical prostatectomy: detailed pathological analysis and prognosis. 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Crossref, Medline, Google Scholar University of Chicago, Chicago, Illinois© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byKates M, Sopko N, Han M, Partin A and Epstein J (2015) Importance of Reporting the Gleason Score at the Positive Surgical Margin Site: Analysis of 4,082 Consecutive Radical Prostatectomy CasesJournal of Urology, VOL. 195, NO. 2, (337-342), Online publication date: 1-Feb-2016.Udo K, Cronin A, Carlino L, Savage C, Maschino A, Al-Ahmadie H, Gopalan A, Tickoo S, Scardino P, Eastham J, Reuter V and Fine S (2012) Prognostic Impact of Subclassification of Radical Prostatectomy Positive Margins by Linear Extent and Gleason GradeJournal of Urology, VOL. 189, NO. 4, (1302-1307), Online publication date: 1-Apr-2013.Spahn M, Briganti A, Capitanio U, Kneitz B, Gontero P, Karnes J, Schubert M, Montorsi F, Scholz C, Bader P, van Poppel H and Joniau S (2012) Outcome Predictors of Radical Prostatectomy Followed by Adjuvant Androgen Deprivation in Patients with Clinical High Risk Prostate Cancer and pT3 Surgical Margin Positive DiseaseJournal of Urology, VOL. 188, NO. 1, (84-90), Online publication date: 1-Jul-2012.Budäus L, Isbarn H, Eichelberg C, Lughezzani G, Sun M, Perrotte P, Chun F, Salomon G, Steuber T, Köllermann J, Sauter G, Ahyai S, Zacharias M, Fisch M, Schlomm T, Haese A, Heinzer H, Huland H, Montorsi F, Graefen M and Karakiewicz P (2010) Biochemical Recurrence After Radical Prostatectomy: Multiplicative Interaction Between Surgical Margin Status and Pathological StageJournal of Urology, VOL. 184, NO. 4, (1341-1346), Online publication date: 1-Oct-2010.Related articlesJournal of Urology18 May 2009Phase II Trial of Capecitabine and Weekly Docetaxel for Metastatic Castrate Resistant Prostate Cancer Volume 182Issue 1July 2009Page: 139-144 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsrecurrenceprostatectomyMetricsAuthor Information Sergey Shikanov Nothing to disclose. More articles by this author Jie Song Nothing to disclose. More articles by this author Cassandra Royce Nothing to disclose. More articles by this author Hikmat Al-Ahmadie Nothing to disclose. More articles by this author Kevin Zorn Financial interest and/or other relationship with Intuitive Surgical and SurgRx, Inc. More articles by this author Gary Steinberg Financial interest and/or other relationship with Vysis, Bioniche and Spectrum. More articles by this author Gregory Zagaja Financial interest and/or other relationship with Intuitive Surgical. More articles by this author Arieh Shalhav Nothing to disclose. More articles by this author Scott Eggener Nothing to disclose. More articles by this author Expand All Advertisement PDF downloadLoading ...
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