Increased number of high-risk factors following radical prostatectomy is associated with decreased biochemical recurrence-free survival in high-risk prostate cancer

Introduction & Objectives : High-risk (HR) prostate cancer (PC) is associated with less favourable biochemical recurrence (BCR) rates and cancer control outcomes following radical prostatectomy. However, HR-PC represents quite a heterogeneous patient group. We evaluate whether number and type of HR factors predicts for BCR-free survival. Materials and Methods : We identified 143 patients with HR-PC who underwent radical prostatectomy (116 open, 27 robot-assisted) at Ghent University Hospital from 1997 until 2012. HR-PC was defined by at least one of 3 HR factors: prostate-specific antigen (PSA) >20 ng/mL, Gleason score ≥8 or stage pT3-4. Mean age was 62,6 (± 5,92) years, mean follow-up was 57 (±43,2) months. Mean PSA was 16,2 (±18,54) ng/mL. Pathological Gleason score was ≤6 in 29 patients (20%), 7 in 62 (43%) and ≥8 in 52 patients (36%). Twenty-one patients (15%) had pT2 PC, 91 (64%) had pT3a, 28 (20%) pT3b and 3 patients (2%) pT4. Adjuvant RT was delivered in 64 patients (45%) because of PSM (n=51), stage pT3b (n=19) or pN1 (n=8). Kaplan-Meier analyses were performed with multivariate Cox regression to correct for delivery of adjuvant RT. Results : Five-year BCR-free survival was 59,4% for the total group and 64,0%, 48,6% and 53,3% for patients with 1, 2 and 3 HR factors respectively. On multivariate Cox regression (figure 1), presence of ≥2 HR factors was associated with worse BCR-free survival (hazards ratio 2,13 [1,12-4,06]; p=0.021). When all HR factors were put in the multivariate regression model, only PSA≥20 ng/mL was independently associated with worse BCR-free survival (hazards ratio 2,11 [1,03-4,31]; p=0.041). Conclusion : Presence of >1 HR factor predicts for less favourable BCR-free survival. HR-PC should be further stratified according to number of HR factors