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Impact of preoperative risk on metastatic progression and cancer‐specific mortality in patients with adverse pathology at radical prostatectomy
Author(s) -
Boehm Katharina,
LeyhBannurah SamiRamzi,
Rosenbaum Clemens,
Brandi Laurenz S.,
Budäus Lars,
Graefen Markus,
Huland Hartwig,
Haferkamp Axel,
Tilki Derya
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13887
Subject(s) - medicine , prostatectomy , prostate cancer , pathological , proportional hazards model , hazard ratio , biochemical recurrence , urology , risk factor , cancer , disease , oncology , confidence interval
Objective To evaluate the impact of preoperative risk category on metastatic disease and prostate cancer‐specific mortality ( CSM ) in patients with prostate cancer ( PC a) with adverse pathology at radical prostatectomy ( RP ). Patients and Methods The records of 6 943 patients who underwent RP at a European tertiary centre were analysed. Biochemical recurrence ( BCR ), metastatic disease and CSM were assessed for patients with adverse pathology at RP , and stratified according to preoperative low‐ vs intermediate‐/high‐risk PC a groups. Kaplan–Meier, cumulative incidence, Cox regression and competing risk regression analyses were performed. Results In patients with extracapsular extension, the metastatic disease rate was 1.6% vs 8% ( P < 0.001) and the CSM rate was 2% vs 5% ( P = 0.041) for low vs intermediate‐/high‐risk patients, respectively, at 10 years. In patients with pathological Gleason score ≥3+4, the metastatic disease rate was 3.0% vs 12% ( P < 0.001) and the CSM rate was 3% vs 8%, respectively ( P < 0.001). In patients with positive surgical margins ( PSM s), the metastatic disease rate was 2.9% vs 15% ( P < 0.001) and the CSM rate was 4% vs 10%, respectively ( P = 0.0001). Low‐risk status was a predictive factor for metastatic disease in patients with pathological Gleason score ≥3+4 (hazard ratio [ HR ] 0.51), pathological Gleason score ≥4+3 ( HR 0.41) and PSM s ( HR 0.46) and was a predictive factor for CSM risk in patients with pathological Gleason score ≥3+4 ( HR 0.62). Conclusions Patients with low‐risk PC a were at significantly lower risk of metastatic disease and CSM than their intermediate‐/high‐risk counterparts, when adverse pathological features were identified at RP . This should be emphasized in the decision‐making process after RP .