Preoperative characteristics of men with unfavorable high-Gleason prostate cancer at radical prostatectomy

Phillip Martin Pierorazio, Brian M. Lin, Jeffrey K. Mullins, M. Eric Hyndman, Edward M. Schaeffer, Misop Han, Alan Wayne Partin, Christian Pavlovich

Research output: Contribution to journalArticle

Abstract

Introduction: Some men with Gleason sum 8-10 prostate cancer (PC) at RP have favorable outcomes: Biochemical recurrence free (BFS) and prostate cancer-specific survival (CSS) are improved for such men with pT2 or pT3a disease compared with pT3b or N1 disease at radical prostatectomy (RP). We examine biopsy characteristics of men with high-grade PC at RP to better select those who may benefit from surgery. Materials and Methods: A total of 1,174 men from our Institutional Database (1982-2010) had Gleason 8-10 cancer at RP. Their demographic and prostate biopsy characteristics were compared among those with disease defined as favorable (pT2 or pT3a) vs. unfavorable (pT3b or N1). Logistic regression was used to determine predictors of unfavorable disease. Kaplan-Meier analysis was used to determine survival outcomes. Results: Biopsy data were available for 1,157 men (median cores 12 [2-20]); 779 (66.4%) favorable, 394 (33.6%) unfavorable; 102 (8.7%), 515 (44.1%), and 552 (47.2%) were low, intermediate, and high-risk. For favorable and unfavorable cases, 10-year BFS was 40.0% and 5.7% (P <0.001) and CSS was 84.9% and 60.3% (P <0.001). Multivariate logistic regression revealed that PSA ≥ 20 and perineural invasion (PNI) at biopsy increased the likelihood of unfavorable, high-grade disease. Considering PSA ≥ 20 and PNI as adverse features, 23.7%, 40.1%, and 71.4% of patients with none, 1, or 2 adverse features had unfavorable, high-Gleason PC (P <0.001). Conclusions: High-Gleason PC was not uniformly associated with poor outcomes after RP, though men with unfavorable (pT3b/N1) disease fared poorly. Preoperative predictors of high-Gleason, unfavorable disease in a cohort of predominantly intermediate and high-risk patients were PSA ≥ 20 and PNI.

Original languageEnglish (US)
Pages (from-to)589-594
Number of pages6
JournalUrologic Oncology: Seminars and Original Investigations
Volume31
Issue number5
DOIs
StatePublished - Jul 2013

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Prostatectomy
Prostatic Neoplasms
Biopsy
Survival
Logistic Models
Kaplan-Meier Estimate
Prostate
Neoplasms
Demography
Databases
Recurrence

Keywords

  • Gleason sum
  • High risk
  • Intermediate risk
  • Outcomes
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Preoperative characteristics of men with unfavorable high-Gleason prostate cancer at radical prostatectomy. / Pierorazio, Phillip Martin; Lin, Brian M.; Mullins, Jeffrey K.; Hyndman, M. Eric; Schaeffer, Edward M.; Han, Misop; Partin, Alan Wayne; Pavlovich, Christian.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 31, No. 5, 07.2013, p. 589-594.

Research output: Contribution to journalArticle

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title = "Preoperative characteristics of men with unfavorable high-Gleason prostate cancer at radical prostatectomy",
abstract = "Introduction: Some men with Gleason sum 8-10 prostate cancer (PC) at RP have favorable outcomes: Biochemical recurrence free (BFS) and prostate cancer-specific survival (CSS) are improved for such men with pT2 or pT3a disease compared with pT3b or N1 disease at radical prostatectomy (RP). We examine biopsy characteristics of men with high-grade PC at RP to better select those who may benefit from surgery. Materials and Methods: A total of 1,174 men from our Institutional Database (1982-2010) had Gleason 8-10 cancer at RP. Their demographic and prostate biopsy characteristics were compared among those with disease defined as favorable (pT2 or pT3a) vs. unfavorable (pT3b or N1). Logistic regression was used to determine predictors of unfavorable disease. Kaplan-Meier analysis was used to determine survival outcomes. Results: Biopsy data were available for 1,157 men (median cores 12 [2-20]); 779 (66.4{\%}) favorable, 394 (33.6{\%}) unfavorable; 102 (8.7{\%}), 515 (44.1{\%}), and 552 (47.2{\%}) were low, intermediate, and high-risk. For favorable and unfavorable cases, 10-year BFS was 40.0{\%} and 5.7{\%} (P <0.001) and CSS was 84.9{\%} and 60.3{\%} (P <0.001). Multivariate logistic regression revealed that PSA ≥ 20 and perineural invasion (PNI) at biopsy increased the likelihood of unfavorable, high-grade disease. Considering PSA ≥ 20 and PNI as adverse features, 23.7{\%}, 40.1{\%}, and 71.4{\%} of patients with none, 1, or 2 adverse features had unfavorable, high-Gleason PC (P <0.001). Conclusions: High-Gleason PC was not uniformly associated with poor outcomes after RP, though men with unfavorable (pT3b/N1) disease fared poorly. Preoperative predictors of high-Gleason, unfavorable disease in a cohort of predominantly intermediate and high-risk patients were PSA ≥ 20 and PNI.",
keywords = "Gleason sum, High risk, Intermediate risk, Outcomes, Prostate cancer",
author = "Pierorazio, {Phillip Martin} and Lin, {Brian M.} and Mullins, {Jeffrey K.} and Hyndman, {M. Eric} and Schaeffer, {Edward M.} and Misop Han and Partin, {Alan Wayne} and Christian Pavlovich",
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T1 - Preoperative characteristics of men with unfavorable high-Gleason prostate cancer at radical prostatectomy

AU - Pierorazio, Phillip Martin

AU - Lin, Brian M.

AU - Mullins, Jeffrey K.

AU - Hyndman, M. Eric

AU - Schaeffer, Edward M.

AU - Han, Misop

AU - Partin, Alan Wayne

AU - Pavlovich, Christian

PY - 2013/7

Y1 - 2013/7

N2 - Introduction: Some men with Gleason sum 8-10 prostate cancer (PC) at RP have favorable outcomes: Biochemical recurrence free (BFS) and prostate cancer-specific survival (CSS) are improved for such men with pT2 or pT3a disease compared with pT3b or N1 disease at radical prostatectomy (RP). We examine biopsy characteristics of men with high-grade PC at RP to better select those who may benefit from surgery. Materials and Methods: A total of 1,174 men from our Institutional Database (1982-2010) had Gleason 8-10 cancer at RP. Their demographic and prostate biopsy characteristics were compared among those with disease defined as favorable (pT2 or pT3a) vs. unfavorable (pT3b or N1). Logistic regression was used to determine predictors of unfavorable disease. Kaplan-Meier analysis was used to determine survival outcomes. Results: Biopsy data were available for 1,157 men (median cores 12 [2-20]); 779 (66.4%) favorable, 394 (33.6%) unfavorable; 102 (8.7%), 515 (44.1%), and 552 (47.2%) were low, intermediate, and high-risk. For favorable and unfavorable cases, 10-year BFS was 40.0% and 5.7% (P <0.001) and CSS was 84.9% and 60.3% (P <0.001). Multivariate logistic regression revealed that PSA ≥ 20 and perineural invasion (PNI) at biopsy increased the likelihood of unfavorable, high-grade disease. Considering PSA ≥ 20 and PNI as adverse features, 23.7%, 40.1%, and 71.4% of patients with none, 1, or 2 adverse features had unfavorable, high-Gleason PC (P <0.001). Conclusions: High-Gleason PC was not uniformly associated with poor outcomes after RP, though men with unfavorable (pT3b/N1) disease fared poorly. Preoperative predictors of high-Gleason, unfavorable disease in a cohort of predominantly intermediate and high-risk patients were PSA ≥ 20 and PNI.

AB - Introduction: Some men with Gleason sum 8-10 prostate cancer (PC) at RP have favorable outcomes: Biochemical recurrence free (BFS) and prostate cancer-specific survival (CSS) are improved for such men with pT2 or pT3a disease compared with pT3b or N1 disease at radical prostatectomy (RP). We examine biopsy characteristics of men with high-grade PC at RP to better select those who may benefit from surgery. Materials and Methods: A total of 1,174 men from our Institutional Database (1982-2010) had Gleason 8-10 cancer at RP. Their demographic and prostate biopsy characteristics were compared among those with disease defined as favorable (pT2 or pT3a) vs. unfavorable (pT3b or N1). Logistic regression was used to determine predictors of unfavorable disease. Kaplan-Meier analysis was used to determine survival outcomes. Results: Biopsy data were available for 1,157 men (median cores 12 [2-20]); 779 (66.4%) favorable, 394 (33.6%) unfavorable; 102 (8.7%), 515 (44.1%), and 552 (47.2%) were low, intermediate, and high-risk. For favorable and unfavorable cases, 10-year BFS was 40.0% and 5.7% (P <0.001) and CSS was 84.9% and 60.3% (P <0.001). Multivariate logistic regression revealed that PSA ≥ 20 and perineural invasion (PNI) at biopsy increased the likelihood of unfavorable, high-grade disease. Considering PSA ≥ 20 and PNI as adverse features, 23.7%, 40.1%, and 71.4% of patients with none, 1, or 2 adverse features had unfavorable, high-Gleason PC (P <0.001). Conclusions: High-Gleason PC was not uniformly associated with poor outcomes after RP, though men with unfavorable (pT3b/N1) disease fared poorly. Preoperative predictors of high-Gleason, unfavorable disease in a cohort of predominantly intermediate and high-risk patients were PSA ≥ 20 and PNI.

KW - Gleason sum

KW - High risk

KW - Intermediate risk

KW - Outcomes

KW - Prostate cancer

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