TY - JOUR
T1 - Natural history of surgically treated high-risk prostate cancer
AU - Briganti, Alberto
AU - Karnes, Robert J effrey
AU - Gandaglia, Giorgio
AU - Spahn, Martin
AU - Gontero, Paolo
AU - Tosco, Lorenzo
AU - Kneitz, Burkhard
AU - Chun, Felix K H
AU - Zaffuto, Emanuele
AU - Sun, Maxine
AU - Graefen, Markus
AU - Marchioro, Giansilvio
AU - Frohneberg, Detlef
AU - Giona, Simone
AU - Karakiewicz, Pierre I.
AU - Van Poppel, Hein
AU - Montorsi, Francesco
AU - Joniau, Steven
AU - European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT)
PY - 2015/4/1
Y1 - 2015/4/1
N2 - BACKGROUND: No data exist on the patterns of biochemical recurrence (BCR) and their effect on survival in patients with high-risk prostate cancer (PCa) treated with surgery. The aim of our investigation was to evaluate the natural history of PCa in patients treated with radical prostatectomy (RP) alone.MATERIALS AND METHODS: Overall, 2,065 patients with high-risk PCa treated with RP at 7 tertiary referral centers between 1991 and 2011 were identified. First, we calculated the probability of experiencing BCR after surgery. Particularly, we relied on conditional survival estimates for BCR after RP. Competing-risks regression analyses were then used to evaluate the effect of time to BCR on the risk of cancer-specific mortality (CSM).RESULTS: Median follow-up was 70 months. Overall, the 5-year BCR-free survival rate was 55.2%. Given the BCR-free survivorship at 1, 2, 3, 4, and 5 years, the BCR-free survival rates improved by+7.6%,+4.1%,+4.8%,+3.2%, and+3.7%, respectively. Overall, the 10-year CSM rate was 14.8%. When patients were stratified according to time to BCR, patients experiencing BCR within 36 months from surgery had higher 10-year CSM rates compared with those experiencing late BCR (19.1% vs. 4.4%; P<0.001). At multivariate analyses, time to BCR represented an independent predictor of CSM (P<0.001).CONCLUSIONS: Increasing time from surgery is associated with a reduction of the risk of subsequent BCR. Additionally, time to BCR represents a predictor of CSM in these patients. These results might help provide clinicians with better follow-up strategies and more aggressive treatments for early BCR.
AB - BACKGROUND: No data exist on the patterns of biochemical recurrence (BCR) and their effect on survival in patients with high-risk prostate cancer (PCa) treated with surgery. The aim of our investigation was to evaluate the natural history of PCa in patients treated with radical prostatectomy (RP) alone.MATERIALS AND METHODS: Overall, 2,065 patients with high-risk PCa treated with RP at 7 tertiary referral centers between 1991 and 2011 were identified. First, we calculated the probability of experiencing BCR after surgery. Particularly, we relied on conditional survival estimates for BCR after RP. Competing-risks regression analyses were then used to evaluate the effect of time to BCR on the risk of cancer-specific mortality (CSM).RESULTS: Median follow-up was 70 months. Overall, the 5-year BCR-free survival rate was 55.2%. Given the BCR-free survivorship at 1, 2, 3, 4, and 5 years, the BCR-free survival rates improved by+7.6%,+4.1%,+4.8%,+3.2%, and+3.7%, respectively. Overall, the 10-year CSM rate was 14.8%. When patients were stratified according to time to BCR, patients experiencing BCR within 36 months from surgery had higher 10-year CSM rates compared with those experiencing late BCR (19.1% vs. 4.4%; P<0.001). At multivariate analyses, time to BCR represented an independent predictor of CSM (P<0.001).CONCLUSIONS: Increasing time from surgery is associated with a reduction of the risk of subsequent BCR. Additionally, time to BCR represents a predictor of CSM in these patients. These results might help provide clinicians with better follow-up strategies and more aggressive treatments for early BCR.
KW - Biochemical recurrence
KW - Cancer-specific mortality
KW - Prostate cancer
KW - Radical prostatectomy
KW - Time to biochemical recurrence
UR - http://www.scopus.com/inward/record.url?scp=85006324744&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85006324744&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2014.11.018
DO - 10.1016/j.urolonc.2014.11.018
M3 - Article
C2 - 25665508
AN - SCOPUS:85006324744
SN - 1078-1439
VL - 33
JO - Urologic Oncology
JF - Urologic Oncology
IS - 4
ER -