Radical prostatectomy as initial monotherapy for patients with pathologically confirmed high-grade prostate cancer

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Abstract

Objective To report the long-term outcome of high-grade prostate cancer treated with radical prostatectomy (RP) as initial monotherapy, analyse the effect of clinical and pathological variables on survival, and report cancer-related symptoms. Patients and Methods A retrospective chart review was conducted to identify patients with Gleason 8-10 prostate cancer found on pathological review in men undergoing RP as initial therapy for clinically localized disease between 1988 and 2005. Kaplan-Meier analysis was used to calculate event-free survival. Univariable and multivariable analyses were used to assess the effects of clinical and pathological variables on prostate-specific antigen (PSA) recurrence. Results After excluding 20 patients, 119 were identified with pathologically confirmed high-grade cancers at the time of RP. The overall median (interquartile range) follow-up was 73 (41-113) months. Twenty-four (20%) patients had organ-confined cancer, 60 (50%) had specimen-confined cancer, and 14 (12%) had nodal metastasis. Kaplan-Meier analysis showed overall survival rates at 5 and 10 years, respectively, of 90% and 75%, cancer-specific survival of 92% and 82%, and a PSA recurrence-free follow-up at 5 years of 31%. Using univariable analysis, preoperative PSA level, pathological Gleason score, pathological stage, surgical margin status and tumour volume were found to significantly affect the PSA recurrence-free follow-up. No variables were significant on multivariable analysis. Cancer-related symptoms were reported by only 14 patients, with a median time from surgery to first symptom of 43 months. Conclusion High-grade prostate cancer can be treated with RP as initial monotherapy with an acceptable 10-year cancer-specific survival (82%). The PSA recurrence-free follow-up is poor (31% at 5 years). However, few patients progress to symptomatic recurrence after PSA relapse within the first 5 years.

Original languageEnglish
Pages (from-to)1372-1376
Number of pages5
JournalBJU International
Volume105
Issue number10
DOIs
StatePublished - May 2010

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Prostatectomy
Prostate-Specific Antigen
Prostatic Neoplasms
Recurrence
Neoplasms
Kaplan-Meier Estimate
Survival
Neoplasm Grading
Tumor Burden
Disease-Free Survival
Survival Rate
Neoplasm Metastasis

Keywords

  • Cancer progression
  • Cancer symptoms
  • Prostatectomy
  • Prostatic neoplasm
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

@article{466be8b53a264855a34acdcc13518c33,
title = "Radical prostatectomy as initial monotherapy for patients with pathologically confirmed high-grade prostate cancer",
abstract = "Objective To report the long-term outcome of high-grade prostate cancer treated with radical prostatectomy (RP) as initial monotherapy, analyse the effect of clinical and pathological variables on survival, and report cancer-related symptoms. Patients and Methods A retrospective chart review was conducted to identify patients with Gleason 8-10 prostate cancer found on pathological review in men undergoing RP as initial therapy for clinically localized disease between 1988 and 2005. Kaplan-Meier analysis was used to calculate event-free survival. Univariable and multivariable analyses were used to assess the effects of clinical and pathological variables on prostate-specific antigen (PSA) recurrence. Results After excluding 20 patients, 119 were identified with pathologically confirmed high-grade cancers at the time of RP. The overall median (interquartile range) follow-up was 73 (41-113) months. Twenty-four (20{\%}) patients had organ-confined cancer, 60 (50{\%}) had specimen-confined cancer, and 14 (12{\%}) had nodal metastasis. Kaplan-Meier analysis showed overall survival rates at 5 and 10 years, respectively, of 90{\%} and 75{\%}, cancer-specific survival of 92{\%} and 82{\%}, and a PSA recurrence-free follow-up at 5 years of 31{\%}. Using univariable analysis, preoperative PSA level, pathological Gleason score, pathological stage, surgical margin status and tumour volume were found to significantly affect the PSA recurrence-free follow-up. No variables were significant on multivariable analysis. Cancer-related symptoms were reported by only 14 patients, with a median time from surgery to first symptom of 43 months. Conclusion High-grade prostate cancer can be treated with RP as initial monotherapy with an acceptable 10-year cancer-specific survival (82{\%}). The PSA recurrence-free follow-up is poor (31{\%} at 5 years). However, few patients progress to symptomatic recurrence after PSA relapse within the first 5 years.",
keywords = "Cancer progression, Cancer symptoms, Prostatectomy, Prostatic neoplasm, Survival",
author = "Clinton Bahler and Richard Foster and Richard Bihrle and Beck, {Stephen D W} and Thomas Gardner and Chandru Sundaram and Timothy Masterson and Liang Cheng and Michael Koch",
year = "2010",
month = "5",
doi = "10.1111/j.1464-410X.2009.08979.x",
language = "English",
volume = "105",
pages = "1372--1376",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Radical prostatectomy as initial monotherapy for patients with pathologically confirmed high-grade prostate cancer

AU - Bahler, Clinton

AU - Foster, Richard

AU - Bihrle, Richard

AU - Beck, Stephen D W

AU - Gardner, Thomas

AU - Sundaram, Chandru

AU - Masterson, Timothy

AU - Cheng, Liang

AU - Koch, Michael

PY - 2010/5

Y1 - 2010/5

N2 - Objective To report the long-term outcome of high-grade prostate cancer treated with radical prostatectomy (RP) as initial monotherapy, analyse the effect of clinical and pathological variables on survival, and report cancer-related symptoms. Patients and Methods A retrospective chart review was conducted to identify patients with Gleason 8-10 prostate cancer found on pathological review in men undergoing RP as initial therapy for clinically localized disease between 1988 and 2005. Kaplan-Meier analysis was used to calculate event-free survival. Univariable and multivariable analyses were used to assess the effects of clinical and pathological variables on prostate-specific antigen (PSA) recurrence. Results After excluding 20 patients, 119 were identified with pathologically confirmed high-grade cancers at the time of RP. The overall median (interquartile range) follow-up was 73 (41-113) months. Twenty-four (20%) patients had organ-confined cancer, 60 (50%) had specimen-confined cancer, and 14 (12%) had nodal metastasis. Kaplan-Meier analysis showed overall survival rates at 5 and 10 years, respectively, of 90% and 75%, cancer-specific survival of 92% and 82%, and a PSA recurrence-free follow-up at 5 years of 31%. Using univariable analysis, preoperative PSA level, pathological Gleason score, pathological stage, surgical margin status and tumour volume were found to significantly affect the PSA recurrence-free follow-up. No variables were significant on multivariable analysis. Cancer-related symptoms were reported by only 14 patients, with a median time from surgery to first symptom of 43 months. Conclusion High-grade prostate cancer can be treated with RP as initial monotherapy with an acceptable 10-year cancer-specific survival (82%). The PSA recurrence-free follow-up is poor (31% at 5 years). However, few patients progress to symptomatic recurrence after PSA relapse within the first 5 years.

AB - Objective To report the long-term outcome of high-grade prostate cancer treated with radical prostatectomy (RP) as initial monotherapy, analyse the effect of clinical and pathological variables on survival, and report cancer-related symptoms. Patients and Methods A retrospective chart review was conducted to identify patients with Gleason 8-10 prostate cancer found on pathological review in men undergoing RP as initial therapy for clinically localized disease between 1988 and 2005. Kaplan-Meier analysis was used to calculate event-free survival. Univariable and multivariable analyses were used to assess the effects of clinical and pathological variables on prostate-specific antigen (PSA) recurrence. Results After excluding 20 patients, 119 were identified with pathologically confirmed high-grade cancers at the time of RP. The overall median (interquartile range) follow-up was 73 (41-113) months. Twenty-four (20%) patients had organ-confined cancer, 60 (50%) had specimen-confined cancer, and 14 (12%) had nodal metastasis. Kaplan-Meier analysis showed overall survival rates at 5 and 10 years, respectively, of 90% and 75%, cancer-specific survival of 92% and 82%, and a PSA recurrence-free follow-up at 5 years of 31%. Using univariable analysis, preoperative PSA level, pathological Gleason score, pathological stage, surgical margin status and tumour volume were found to significantly affect the PSA recurrence-free follow-up. No variables were significant on multivariable analysis. Cancer-related symptoms were reported by only 14 patients, with a median time from surgery to first symptom of 43 months. Conclusion High-grade prostate cancer can be treated with RP as initial monotherapy with an acceptable 10-year cancer-specific survival (82%). The PSA recurrence-free follow-up is poor (31% at 5 years). However, few patients progress to symptomatic recurrence after PSA relapse within the first 5 years.

KW - Cancer progression

KW - Cancer symptoms

KW - Prostatectomy

KW - Prostatic neoplasm

KW - Survival

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U2 - 10.1111/j.1464-410X.2009.08979.x

DO - 10.1111/j.1464-410X.2009.08979.x

M3 - Article

C2 - 19863521

AN - SCOPUS:77951757683

VL - 105

SP - 1372

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JO - BJU International

JF - BJU International

SN - 1464-4096

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