Impact of different definitions of high-risk prostate cancer on survival after radical prostatectomy.

113 Background: Multiple definitions of high risk prostate cancer exist. Studies have primarily correlated these definitions with biochemical recurrence and not with survival. We applied six previously described high risk definitions to men treated with radical prostatectomy and evaluated their ability to predict survival outcomes in a multi-institutional cohort. Methods: The study population included 6477 men treated with radical prostatectomy between 1995 and 2005 and followed for a median of 67 months. The six high risk definitions were 1) preoperative PSA≥20ng/ml, 2) biopsy Gleason score 8-10, 3) clinical stage≥T2c, 4) clinical stage T3, 5) D’Amico definition, or 6) National Comprehensive Cancer Network definition. Survival was evaluated with the Kaplan-Meier method to generate unadjusted prostate cancer survival estimates. To control for the competing risks of age and comorbidity, multivariable Cox proportional hazard regression models were used to estimate the hazard ratio for prostate cancer specific mortality (PCSM) and overall mortality (OM) in high risk patients compared to low/intermediate risk. Results: High risk patients comprised between 0.7% (cT3) and 8.2% (D’Amico) of the study population. The 10-year Kaplan Meier prostate cancer survival estimates varied from 89.7% for PSA≥20 to 69.7% for cT3. On multivariable analysis controlling for age and comorbidity, high risk prostate cancer (of all definitions) had an increased risk of PCSM compared to low/intermediate risk with a hazard ratio (HR) ranging from 4.38 for PSA≥20 to 19.97 for cT3 (all p<0.0001). For OM, again controlling for age and comorbidity, high risk patients of all definitions except preoperative PSA≥20 (HR=0.98, p=0.99) were associated with increased risk of OM (HR range: 1.72 for D’Amico, 1.73 for stage≥T2c, 1.88 for NCCN, 2.63 for Gleason 8-10, 3.31 for cT3; all p<0.01). Conclusions: In a contemporary cohort of men with high risk prostate cancer treated with radical prostatectomy, the majority of men experienced long term prostate cancer survival. However, heterogeneity in survival outcomes existed based on the definition of high risk used. Clinical stage T3 and high Gleason score were most strongly associated with PCSM and OM.

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Increasing overall survival with neoadjuvant and concomitant hormonal therapy plus conformal radiotherapy for high risk prostate cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14641 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14641-14641

Author(s):

M. R. Cruz ◽

R. A. Nakamura ◽

C. R. Monti ◽

J. C. Prestes ◽

F. A. Trevisan ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Cancer Patients ◽

Gleason Score ◽

Clinical Stage ◽

Conformal Radiotherapy ◽

Seminal Vesicles ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

Risk Patients

14641 Objective: To evaluate the value of neoadjuvant (NHT) and concomitant hormonal therapy (CHT) for high risk prostate cancer patients treated with conformal radiotherapy (3DCRT). Methods: From October 1997 to January 2002, 116 patients with high risk prostate cancer were submitted to 3DCRT and were analyzed retrospectively. High risk patients were defined as patients with PSA >20 ng/ml, and/or T3 clinical stage and/or Gleason score >7, or two factors of intermediate risk (PSA ≥10 and <20 ng/ml, T2b-T2c and Gleason score >7). The NHT and CHT were performed on 69 (59.5%) and 79 (68.1%) patients, respectively. The prostate and seminal vesicles median doses were 81 Gy (72–82.8) and 61.2 Gy (45–77.4) respectively. The median time from diagnosis to 3DCRT was 2,9 months (0.9–134.9). Results: On median follow-up of 54.5 months (13.5–93.9), the 5-year actuarial overall (OS) and 5-year biochemical progression-free survival (BPFS) were 84.3% and 64.7% respectively. The OS for patients submitted to NHT was 89.8% versus 76.4% for patients that were not submitted to (p = 0.0139). Patients that received CHT had an OS of 89.6% versus 73.4% for patients that did not receive CHT (p = 0.0201). Gleason score, clinical stage and seminal vesicles irradiation were significant to BPFS (p = 0.0372, p = 0.0412 and p = 0.0321 respectively). Conclusions: NHT and CHT increased OS of high risk prostate cancer of patients. Gleason score and clinical stage were important prognostic factors to BPFS. Seminal vesicles irradiation is recommended for high risk patients. No significant financial relationships to disclose.

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Short Term Outcomes in Indian Patients with High Risk Prostate Cancer after Laparoscopic Radical Prostatectomy- Data from a Single Institute

annals of urologic oncology ◽

10.32948/auo.2020.09.29 ◽

2020 ◽

pp. 1-10

Author(s):

Prashant Patel ◽

Shrenik J Shah ◽

Arpan Choudhary

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Clinical Stage ◽

Laparoscopic Radical Prostatectomy ◽

Pathological Stage ◽

Short Term ◽

Term Survival ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

Background Management of high risk prostate cancer (HRPC) is in evolving stage. Effectiveness of the various treatment strategies is being explored. We examined the short term efficacy of laparoscopic radical prostatectomy (LRP) in treatment of patients with HRPC. Methods Retrospective observational study had 140 HRPC patients of Indian origin, based on D’Amico classification system. Baseline workup was completed. Perioperative parameters and pathological findings were recorded. Multivariate analysis was performed to find predictive factors of pathological stage and PSM. 5 year biochemical recurrence free survival (BCRFS), cancer specific survival (CSS) and overall survival (OS) were calculated. Results Mean age and PSA were 67.24±7.37 years and 23.29 ng/ml respectively. Three fourth of patients had a biopsy GS ≥8. 53.6% of patients were of clinical stage (CS) ≤T2; while 46.4% were of stage ≥T3. Conversion to open surgery rate was 15%. Mean operative time was 210 minutes; blood loss 230 ml; hospital stay 3 days; catheterization time 14 days; grade II or more complication rate 22.1%; LN positivity 20.0%; PSM rate 25.7%; upstaging 35.7%; down-staging 14.3%; pT2 31.4%; pT3a 26.4%; pT3b 42.2%. GS and CS were predictive of pathological stage and PSM respectively. 89.3% of cases were continent postoperatively. 5 year BCRFS, CSS and OS were 68.3%, 89.2% and 78.7% respectively. Conclusions LRP is feasible and effective initial treatment for HRPC. Perioperative morbidity is acceptable. Accurate staging helps in better planning of the adjuvant therapy. Good short term survival can be achieved with multimodal therapy.

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Long-term oncologic outcomes of neoadjuvant chemohormonal therapy followed by radical prostatectomy for patients with clinically localized, high-risk prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.153 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 153-153

Author(s):

Jonathan L Silberstein ◽

Stephen A Poon ◽

Daniel Sjoberg ◽

Andrew J. Vickers ◽

Aaron Bernie ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Clinical Stage ◽

Specific Antigen ◽

Oncologic Outcomes ◽

Chemohormonal Therapy ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

153 Background: To determine long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemo-hormonal therapy for clinically localized, high-risk prostate cancer. Methods: In this phase II multicenter trial of patients with high-risk prostate cancer (prostate-specific antigen greater than 20ng/ml, Gleason greater than or equal to 8, or clinical stage greater than or equal to T3), androgen deprivation therapy (goserelin acetate depot) and paclitaxel, carboplatin and estramustine were administered prior to RP. We report the long-term oncologic outcomes of these patients and compared them to a contemporary cohort who met oncologic inclusion criteria but received RP only. Results: Thirty four patients were enrolled in this study and followed for a median of 13.1 years. Within 10 years most patients experienced biochemical recurrence (BCR-free probability= 22%; 95% CI 10%, 37%). However the probability of disease-specific survival at 10 years was 84% (95% CI 66%, 93%) and overall survival was 78% (95% CI 60%, 89%). The chemohormonal therapy group had higher-risk features than the comparison group (N=123 patients) with an almost doubled risk of calculated preoperative 5-year BCR (69% vs 36%, p<0.0001). After adjusting for these imbalances the CHT group had trends toward improvement in BCR (0.76, 95% CI 0.43, 1.34; p=0.3) and metastasis free survival (0.55, 95% CI 0.24, 1.29; p=.2) although these were not significant. Conclusions: Neoadjuvant chemohormonal therapy followed by RP was associated with lower observed rates of BCR and metastasis compared to a prostatectomy only group; however these results were not significant. Because this treatment strategy has known harms and unproven benefit, this strategy should only be instituted in the setting of a clinical trial.

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Neoadjuvant Chemotherapy prior to Radical Prostatectomy for Patients with High-Risk Prostate Cancer: A Systematic Review

Chemotherapy Research and Practice ◽

10.1155/2013/386809 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7

Author(s):

Stavros Sfoungaristos ◽

Vasileios Kourmpetis ◽

Eleftherios Fokaefs ◽

Petros Perimenis

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

High Risk ◽

Radical Prostatectomy ◽

Neoadjuvant Chemotherapy ◽

Clinical Problem ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

Risk Patients ◽

Hormone Resistant Prostate Cancer

High-risk prostate cancer represents a pretentious clinical problem since a significant number of its patients will relapse and progress after radical prostatectomy. Neoadjuvant chemotherapy may be valuable since its efficacy in hormone-resistant prostate cancer has been established. In this paper, we report studies of neoadjuvant chemotherapies that have been used in high-risk patients prior to radical prostatectomy. Even though the results regarding the prognostic surrogates are not significant, the effects on clinical and pathological outcomes are promising, while toxicity in most of the studies is in the expected field.

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Prostate-specific antigen density predicts extracapsular extension and increased risk of biochemical recurrence in patients with high-risk prostate cancer who underwent radical prostatectomy

International Journal of Clinical Oncology ◽

10.1007/s10147-014-0696-0 ◽

2014 ◽

Vol 20 (1) ◽

pp. 176-181 ◽

Cited By ~ 12

Author(s):

Takuya Koie ◽

Koji Mitsuzuka ◽

Takahiro Yoneyama ◽

Shintaro Narita ◽

Sadafumi Kawamura ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Extracapsular Extension ◽

High Risk Prostate Cancer ◽

Increased Risk ◽

Prostate Specific Antigen Density ◽

Risk Prostate Cancer

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IMRT pelvic radiotherapy with simultaneous integrated boost in high-risk prostate cancer: Results after 10 years.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.5084 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 5084-5084

Author(s):

Christian Ekanger ◽

Olav Dahl

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Simultaneous Integrated Boost ◽

Free Survival ◽

High Risk Patients ◽

High Risk Prostate Cancer ◽

Gu Toxicity ◽

Risk Prostate Cancer ◽

Integrated Boost ◽

Risk Patients

5084 Background: To report 10 year results after image guided intensity-modulated radiotherapy (IMRT) with hypofractionated simultaneous integrated boost (SIB) in high-risk prostate cancer. Methods: Between 2007 and 2009, 97 patients with an estimated risk of lymph node metastases above 15% (Roach equation) were prospectively included in a phase II study. Patients were treated with 2-2.7 Gy to the prostate, vesicula seminalis and elective pelvic field in 25 fractions over 5 weeks with androgen deprivation therapy for 2 years. Toxicity was scored according to RTOG criteria and biochemical free survival (BFS) using the Phoenix definition. Patients were divided into three groups; very high-risk patients (VHR) according to NCCN 2015 criteria (n=50), high-risk patients (HR) (n=32), and patients with N+ disease and/or pretreatment s-PSA ≥100 (n=15). Differences were examined using Kaplan Meier estimates with log rank test. Results: Ten year BFS in the entire cohort was 63%. Metastasis-free survival (MFS) was 77% and prostate-cancer-specific-survival (PCSS) 88%. Overall survival (OS) was 69% and local failure rate was 11%. VHR vs. HR subgroups had significant different BFS; 58% vs 84% (p=0.01) respectively. MFS and PCSS in the VHR group compared to the HR group was 78% vs 91% (p=0.108) and 86% vs 97% (p=0.157) respectively. Patients with N+ and/or PSA>100 had worse outcome compared to the HR/VHR groups, but not all had treatment failure. BFS was 33% vs 68% (p=0.001), MFS 47% vs 83% (p=0.000) and PCSS 73 % vs 90% (p=0.04), respectively. Patients who reached a PSA nadir value below 0.1 (n=80) had significant better outcomes, with PCSS 93% vs 65% (p= 0.001) and BFS 74% vs 12% (p=0.000), respectively. Acute gr 2 GI and GU toxicity was observed in 27% and 40%, gr 3 GI and GU toxicity in 1% and 3%. Late gr 2 GI and GU toxicity at 3 years appeared in 3% and 4% with no gr 3 toxicity. Conclusions: High-risk prostate cancer patients treated with IMRT with SIB obtained favorable outcomes with few serious side effects. There were significant better results in the HR versus the VHR group, both better than the N+/PSA≥100 group.

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