Study Supports RP Use for High-Risk Prostate Cancer

MILAN—Patients with high-risk prostate cancer (PCa) who undergo radical prostatectomy do not necessarily have a poor prognosis, researchers reported at the 28th annual congress of the European Association of Urology.

Complete surgical resection and biochemical recurrence (BCR)- and metastases-free survival can be achieved, particularly among patients with only one positive risk factor, according to investigators Andreas Becker, MD, and colleagues at the Martini-Clinic Prostate Cancer Center in Hamburg, Germany.

As a result of study findings, the investigators concluded that RP should not be denied to otherwise appropriate surgical candidates because of a high-risk preoperative profile.

Dr. Becker's team identified 2,196 patients with high-risk PCa, defined as a PSA above 20 ng/mL and/or a Gleason score of 8 or higher and/or T2c or greater disease. The median follow-up was 28 months for the 1,659 patients (76%) who had follow-up data available. BCR, which was defined as a PSA rise greater than 0.2, occurred in 592 patients (36%) and clinically evidence metastases developed in 118 (7%).

The five-year BCR-free survival rates were 55.3%, 29.1%, and 13.6% for patients who had one, two, and three risk factors, respectively. The five-year metastasis-free survival rates were 91.1%, 84.9%, and 71.7%, respectively.

In multivariable analyses, a PSA level above 20 was associated with a significant 2.4 times increased risk of BCR and 1.6 times increased risk of clinical metastases compared with a PSA level of 20 or less. A Gleason score of 8 or higher was associated with a significant 2.2 times increased risk of BCR and a non-significant 1.5 times increased risk of clinical metastases compared with a Gleason score less than 8. Clinical stage T2c and higher was associated with a significant 50% increased risk of BCR and 2.1 times increased risk of clinical metastases compared with less advanced clinical stages.

A total of 1,864 patients (85%) had one risk factor, 308 (14%) had two risk factors, and 24 (1%) had three risk factors. Gleason 8 or higher disease was present in 1,187 patients (54%), a PSA level above 20 was presented in 875 patients (39%), and T2c or greater disease was present in 578 patients (26%).

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