Radical Prostatectomy For Incidental (Stage T1a-T1b) Prostate Cancer: Analysis Of Predictors For Residual Disease And Biochemical Recurrence

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 30 May 2008 - 0:00 PDT

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UroToday.com - Up to 16% of men undergoing surgical treatment for BPH will be found to have prostate cancer (CaP). Studies suggest that approximately one-third of these patients will experience biochemical progression within 4 years if untreated. In the online version of European Urology, Dr. Capitanio and colleagues including Dr. Francesco Montorsi report on a cohort of such patients and examine clinical variables to predict outcomes.

A total of 126 cases of incidental CaP in patients undergoing surgical treatment of BPH who were then treated with radical prostatectomy (RP) between 1995 and 2007 were identified. Any patients with a PSA greater than 4.0ng/ml had at least one prostate biopsy prior to BPH surgery. BPH surgery consisted of a TURP in 84 men, simple open prostatectomy in 23 or holmium laser enucleation in 19. All patients had an RP within 6 months of their BPH treatment. Patients had PSA follow-up and biochemical recurrence was defined as a PSA level >0.2ng/ml and rising. Regression models assessed the association between all variables and the residual CaP at RP.

Only PSA before BPH surgery was significantly different for pT1a (< 5% CaP in the BPH specimen) and pT1b (>5% CaP in the specimen or Gleason score >7). At RP, 21 men (16.7%) had no residual cancer. Of the other 105 men, 98 (77.7%) had organ-confined CaP and 7 (5.6%) had extracapsular extension. Seminal vesicles were invaded in 2 cases and lymph node metastases were found in 1 of 155 patients who had a pelvic lymphadenectomy. PSA before surgery for BPH and Gleason score at surgery for BPH were independent predictors for the presence of residual disease. Age, stage and prostate volume were not significantly associated with presence of residual disease. Patients with very low PSA levels after surgery for BPH (<1ng/ml) and Gleason Score <6 at BPH pathology were highly likely (83.2%) not to have residual CaP at the time of RP.

At a mean follow-up of 57 months, PSA recurrence happened in 7 men (4 pT1a and 3pT1b). The 5- and 10-year biochemical recurrence-free survival rates after RP were 92% and 87%, for pT1a and pT1b patients, respectively.

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

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