Evaluation of D'Amico criteria for low-risk prostate cancer

Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched single-centre study

OBJECTIVE

To assess the long-term safety of nerve-sparing radical prostatectomy (NSRP) in men with high-risk prostate cancer (PCa) by comparing survival outcomes, disease recurrence, the need for additional therapy, and perioperative outcomes of patients undergoing NSRP to those having non-NSRP.

PATIENTS AND METHODS

We included consecutive patients at a single, academic centre who underwent open RP for high-risk PCa, defined as preoperative prostate-specific antigen level of > 20 ng/mL and/or postoperative International Society of Urological Pathology Grade Group 4 or 5 (i.e., Gleason score ≥ 8) and/or ≥pT3 and/or pN1 assessing the RP and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of patients with high-risk PCa who underwent NSRP vs non-NSRP. We analysed oncological outcome as time-to-event and calculated hazard ratios (HRs).

RESULTS

A total of 726 patients were included in this analysis of which 84% (n = 609) underwent NSRP. There was no evidence for the positive surgical margin rate being different between the NSRP and non-NSRP groups (47% vs 49%, P = 0.64). Likewise, there was no evidence for the need for postoperative radiotherapy being different in men who underwent NSRP from those who underwent non-NSRP (HR 0.78, 95% confidence interval [CI] 0.53-1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95% CI 0.73-1.34, P = 0.09) and there was no evidence for survival being different in men who underwent NSRP to those who underwent non-NSRP (HR 0.65, 95% CI 0.39-1.08). There was also no evidence for the cancer-specific survival (HR 0.56, 95% CI 0.29-1.11) or progression-free survival (HR 0.99, 95% CI 0.73-1.34) being different between the groups.

CONCLUSION

In patients with high-risk PCa, NSRP can be attempted without compromising long-term oncological outcomes provided a comprehensive assessment of objective (e.g., T Stage) and subjective (e.g., intraoperative appraisal of tissue planes) criteria are conducted.

Recaída bioquímica en cáncer de próstata de bajo riesgo tratados con prostatectomía radical y linfadenectomía pélvica

Objetivo La linfadenectomía pélvica ampliada es el método más confiable para identificar compromiso ganglionar en cáncer de próstata, sin embargo, la morbilidad, el tiempo quirúrgico, el papel terapéutico y las complicaciones, han sido temas de debate. El objetivo del estudio fue describir las características clínicas y patológicas de acuerdo con la presentación de recaída bioquimíca de los pacientes con cáncer de próstata de bajo riesgo tratados con prostatectomía radical más linfadenectomía pélvica ampliada.

Métodos Estudio descriptivo longitudinal retrospectivo en una cohorte de pacientes con cáncer de próstata de bajo riesgo tratados quirúrgicamente, entre enero 2006 hasta diciembre 2016. Se revisaron 210 historias clínicas, 178 cumplían los criterios de inclusión: PSA < 10 ng/mL; Gleason < 6, cT1–cT2a, revisión de las biopsias de próstata y procedimientos quirúrgicos realizados en la misma institución. Las variables a evaluar: porcentaje de compromiso tumoral, invasión linfovascular, concordancia de gleason, numero de ganglios resecados, ganglios positivos, densidad ganglionar, recaída bioquímica.

Resultados 178 pacientes con: 64 años, 62% T1c, psa de 6,37, compromiso de biopsia 23%. El 47% estaban subestadificados por gleason, con un promedio de ganglios resecados de 21, el compromiso ganglionar se encontró en un 3%, los bordes positivos en un 34% y la recaída bioquímica en un 19%. De los 33 pacientes con recaída bioquímica, el 6% tenían ganglios positivos y el 79% tenían bordes positivos, comparado con los que no recayeron: el 1% tenían ganglios positivos y el 23% eran R1, mientras que la invasión linfovascular solo estuvo presente en el 6% vs el 1% sin recaída. El tiempo a la recaída fue de 26 meses.

Conclusiones El compromiso ganglionar en cáncer de próstata es bajo, pero la subestadificación es alta. En el grupo de recaída bioquímica se observó que la mayoría de los pacientes presentaban bordes positivos y una subestadificacion del Gleason.

Impact of the 2014 International Society of Urological Pathology Grading System on Concept of High-Risk Prostate Cancer: Comparison of Long-Term Oncological Outcomes in Patients Undergoing Radical Prostatectomy

Objective: To investigate the relationship between the new International Society of Urological Pathology (ISUP) grading system, biochemical recurrence (BCR), clinical progression (CP) and cancer related death (CRD) after open radical prostatectomy (RP) and determine whether the 2014 ISUP grading system influences the concept of high-risk prostate cancer (HRPCa). Patients and Methods: A total of 1,754 men who underwent RP from 2005 to 2017 were identified from a database at a single tertiary institution. Histopathology reports were reassessed according to the 2014 ISUP grading system. All preoperative, pathological, and clinical follow-up data were obtained. Univariable and multivariable Cox regression, Kaplan-Meier and log-rank analyses were performed. Results: At a median (quartiles) follow-up of 83 (48-123) months, 446 men (25.4%) had BCR, 77 (4.4%) had CP and 39 (2.2%) died from cancer. Grade groups 1, 2, 3, 4, and 5 were detected in 404 (23%), 931 (53.1%), 200 (11.4%), 93 (5.3%), and 126 (7.2%), respectively. 10-year biochemical progression free survival difference between Grade group 3 and 4 was minor but significant (log-rank p = 0.045). There was no difference between Grade groups 3 and 4 comparing 10-year clinical progression free and 10-year cancer specific survival: p = 0.82 and p = 0.39, respectively. Group 5 had the worst survival rates in comparison with other groups (from p < 0.005 to p < 0.0001) in all survival analyses. Pathological stage (hazard ratio (HR) 2.6, p < 0.001), positive surgical margins (HR 2.2, p < 0.0001) and Grade group (HR 10.4, p < 0.0001) were independent predictors for BCR. Stage and Grade group were detected as independent predictors for CP-HR 6.0, p < 0.0001 and HR 35.6, p < 0.0001, respectively. Only Grade group 5 (HR 12.9, p = 0.001) and pT3b (HR 5.9, p = 0.001) independently predicted CRD. Conclusions: The new ISUP 2014 grading system is the most significant independent predictor for BCR, CP, and CRD. Grade group 3 and 4 had similar long-term disease progression survival rates and could potentially be stratified in the same risk group. High-risk cancer associated only with group 5.

Long-term outcomes of nonpalpable prostate cancer (T1c) patients treated with radical prostatectomy

PURPOSE

Various strategies have been used to treat patients with nonpalpable prostate cancer (T1c). As one of the treatments for this stage, a radical prostatectomy was performed and the outcomes were evaluated.

METHODS

Between 1993 and 2002, 117 patients with T1c received a radical prostatectomy and their follow-up were examined by the end of 2013. Patients were classified according to risk groups using prostate-specific antigen (PSA) and Gleasson score, and outcomes of respective groups were compared.

RESULTS

Approximately 60% of patients were in low risk group, and the remaining patients were grouped into the intermediate or high risks in half. In 22% insignificant cancer was detected. Biochemical failure occurred in 14%. One patient exhibited bone metastasis, but no deaths from prostate cancer ware observed. The five and ten year overall survival rates were 92% and 75%, respectively, and the biochemical failure-free survival rates were 92% and 89%, respectively. No different outcomes were observed for the different risk groups in the overall and biochemical failure-free survival rates. T1c tumors contain a certain range of various stages of tumors, but most patients experienced favorable outcomes.

CONCLUSION

Radical prostatectomy as monotherapy is one of the treatment option for T1c prostate cancer patients, who have a long life span and belong to intermediate or high risk groups.