Men with clinically localized high-risk prostate cancer (PCa) do not have a uniformly poor prognosis after radical prostatectomy (RP), researchers found.

“RP should be considered a valid treatment modality for high-risk prostate cancer patients, as many can be surgically down-staged,” the authors concluded in BJU International (2011;107:765-770).

In a study, they showed that the rate of favorable pathology and biochemical recurrence (BCR)-free survival may vary substantially, depending on the definition used.

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Of 4,760 PCa patients who underwent RP at three institutions, 293 (6.2%) had clinical stage T3, 269 (5.7%) had a biopsy Gleason sum of 8 or higher, 370 (7.8%) had preoperative PSA levels of 20 ng/mL or higher, and 887 (18.6%) were considered high-risk according to the D’Amico classification (clinical stage T2c or higher or PSA level of 20 or higher, or biopsy Gleason sum of 8 or higher).

The investigators, led by Pierre I. Karakiewicz, MD, of the Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, assessed actuarial BCR-free survival probabilities after RP and the rate of favorable pathology (organ-confined cancer, negative surgical margin and Gleason 7 or less).

The median follow-up period was 2.4 years; 1,179 (24.8%) patients had more than five years of follow up. According to the researchers, the rate of favorable pathology increased as follows: clinical stage T3 (13.7%), biopsy Gleason of 8 or higher (16.4%), the D’Amico high-risk group (21.4%), and PSA of 20 or higher (21.6%).

The five-year BCR-free survival probabilities were 35.4% for Gleason 8 or higher, 39.8% for PSA of 20 or higher, 47.4% for D’Amico high-risk group, and 51.6% for clinical stage T3, the team reported.

Patients with only one risk factor had the most favorable five-year BCR-free survival (50.3%) compared with men who had two or more risk factors (27.5%).