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Pathological findings and prostate‐specific antigen outcomes after laparoscopic radical prostatectomy for high‐risk prostate cancer
Author(s) -
Ploussard Guillaume,
Salomon Laurent,
Allory Yves,
Terry Stéphane,
Vordos Dimitri,
Hoznek Andreas,
Abbou ClaudeClément,
Vacherot Francis,
De La Taille Alexandre
Publication year - 2010
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/j.1464-410x.2009.09080.x
Subject(s) - medicine , prostate cancer , prostatectomy , urology , prostate specific antigen , stage (stratigraphy) , proportional hazards model , laparoscopic radical prostatectomy , prostate , biochemical recurrence , pathological , biopsy , cancer , lymph node , oncology , paleontology , biology
Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To review the biochemical recurrence‐free survival (RFS) rates of laparoscopic radical prostatectomy (LRP) in patients with a high risk of disease progression as defined by preoperative criteria of D’Amico et al.PATIENTS AND METHODS Between October 2000 and May 2008, 110 patients had extraperitoneal LRP and bilateral pelvic lymph node sampling for high‐risk prostate cancer in our department. High‐risk prostate cancer was defined as a prostate‐specific antigen (PSA) level of >20 ng/mL, and/or a biopsy Gleason score ≥8, and/or a clinical stage of T2c–T4 stage. The median follow‐up was 37.6 months. Risk factors for time to biochemical recurrence were tested using log‐rank survivorship analysis and Cox proportional hazards regression. RESULTS Prostate cancer was organ‐confined in 36% of patients; the Overall RFS was 79.4% and 69.8% at 1 and 3 years, respectively. The 3‐year RFS rates for organ‐confined cancer vs extracapsular extension were 100% and 54.3%, respectively ( P < 0.001). The 3‐year RFS rates for tumour‐free seminal vesicle vs seminal vesicle invasion were 81.8% and 33.6%, respectively ( P < 0.001). The 3‐year RFS rates for negative surgical margins vs positive were 85.2% and 47.3%, respectively ( P = 0.001). Compared with men with any single pathological risk factor or any two risk factors, men with all three risk factors had a significantly shorter time to PSA failure after LRP (log‐rank test, P < 0.001). CONCLUSION Among patients at increased risk of disease progression as defined by preoperative criteria, a third of men with organ‐confined disease have a favourable prognosis. Men at high risk for early PSA failure could be better identified by pathological assessment of RP specimens, and selected for phase III randomized trials investigating adjuvant systemic treatment.