After Radical Retropubic Prostatectomy 'Insignificant' Prostate Cancer Has A Risk Of Progression Similar To Low Risk 'Significant' Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 08 Mar 2008 - 0:00 PDT

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UroToday.com- In a report in the January, 2008 issue of the British Journal of Urology International, Dr. Sengupta and associates from the Mayo Clinic assess the risk of progression and death among patients with pathologically insignificant tumors after radical prostatectomy (RP) for prostate cancer (CaP). Insignificant CaP was defined as a pre-surgical PSA <10ng/ml, a cancer volume of <0.5ml, a pathologic Gleason score <7, and pathological stage
A total of 6,496 patients eligible for the study were identified in the Mayo Clinic Prostatectomy Registry. Preoperative clinical variables were reviewed to include PSA doubling time (PSADT) when available. Cancer volume was obtained by 3-dimensional measurement of the largest tumor nodule. Endpoints included biochemical progression-free survival (bPFS) as defined by a PSA level >0.4ng/ml, systemic PFS (sPFS) defined as a positive bone scan or biopsies of other sites of CaP, cancer-specific survival (CSS), and overall survival (OS).

Insignificant CaP was found in 354 (5.5%) patients and the pathological features of these tumors were more favorable than those with "significant" tumors. These men were younger, less likely to have palpable disease, or Gleason scores of >7. PSADT was evaluable in only 159 men with insignificant CaP and 1,950 men with significant CaP. A PSADT of <1 year was present in a similar proportion of both groups. However, among men with insignificant tumors, a PSADT of 1-10 years was less frequent and a PSADT of >10 years more frequent. Significant univariate predictors of insignificant pathology at RP included age, clinical stage, biopsy Gleason score, and PSADT. It was not possible to assess extent of CaP on biopsy, as most were performed at other institutions. On multivariate analysis, all these factors remained significant except age. Clinical stage had the strongest association. At a median follow-up of 9.2 years, only one man with insignificant CaP developed metastasis and none had died from CaP. The 10 year bPFS (87% vs. 66%), sPFS (100% vs. 94%), OS (91% vs. 85%), and CSS (100% vs. 97%) were each significantly better for men with insignificant vs. significant CaP, respectively. The investigators further defined 1,287 patients with low-risk CaP in the significant CaP group. The bPFS, sPFS, OS, and CSS were similar among the low-risk men and those with insignificant CaP.

Thus, the 10 year risk of metastatic progression and death is close to non-existent among patients with insignificant CaP, but the risk of biochemical recurrence is 13%. Whether the differences in the definitions of insignificant and low-risk CaP need reassessment is a question raised by this study. Sengupta S, Blute ML, Bagniewski SM, Inman B, Leibovich BC, Slezak JM, Myers RP and Zincke H

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