The Specific Definition Of High Risk Prostate Cancer Has Minimal Impact On Biochemical Relapse-Free Survival

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 12 Jan 2009 - 2:00 PDT

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UroToday.com - In the online edition of the Journal of Urology, Dr. Carvell T. Nguyen and colleagues from the Cleveland Clinic examined the application of different definitions of high risk prostate cancer (CaP) to a population of patients at the Cleveland Clinic to determine if the definition used affected biochemical relapse-free survival (BPFS). They cited that over 40 risk stratification models have been reported in the literature, but little analysis has compared their relative predictive power.

This study determined the probability of BPFS following radical prostatectomy (RP) based upon the definition of high-risk disease used. The researchers used their institutional database of men who had undergone RP with or without neoadjuvant therapy between 1987 and 2007. Patients with high risk CaP were identified based on 6 definitions. Median PSA follow-up was 44 months and 5-years follow-up was available in 1,632 patients. Treatment failure was defined as a PSA of 0.4ng/ml or greater and increasing, or the initiation of salvage therapy.

More men were categorized as high risk in early vs. late PSA eras. According to the 6 definitions of high risk CaP used, the 5 and 10-year BRFS rates ranged from 36% to 58% and 25% to 43%, respectively. Univariate analysis demonstrated that high-risk patients had a 2.7 to 5.3-fold increased hazard of biochemical relapse compared to those in non-high risk groups. The BRFS rates were worse during the period 1987 to 1995 compared to those treated in the later period. Stratification by using clinical stage T2b as a cut point resulted in BRFS rates that were relatively better than those for any of the other criteria, while stratification by biopsy, Gleason score, of PSA >20ng/ml resulted in generally lower rates of BRFS. There was minimal variability of BRFS curves among the various high-risk groups in each era. The rates of BRFS and hazard ratios were comparable for each definition when patients who received neoadjuvant therapy were excluded. Overall, BRFS after RP did not vary based upon the definition of high risk CaP applied.

Nguyen CT, Reuther AM, Stephenson AJ, Klein EA, Jones JS
J Urol. 2008 Nov 12. Epub ahead of print.
doi:10.1016/j.juro.2008.09.027

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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