Introduction

To assess survival and competing causes of mortality in prostate cancer (PCa) patients referred to radical prostatectomy (RP) through a combination of pathologic adverse features (AFs).

Methods

A single Tertiary Referral academic institution cohort of 2886 consecutive patients who underwent open or laparoscopic RP and pelvic lymph node dissection (PLND) for PCa between November 1995 and April 2015 was evaluated. Patients referred to neoadjuvant therapy and those lacking clinical, pathologic, and follow-up data were excluded. The final population consisted of 615 patients with at least one AF: preoperative PSA ?20 ng/mL, pathologic Gleason score ?8 and no organ-confined disease at final pathology (seminal vesicle involvement, and/or positive surgical margins, and/or lymph node invasion). Kaplan-Meier analyses were used to assess cancer-specific mortality (CSM)-free survival rates by stratifying patients into 3 risk categories according to the number of AFs (namely, 1, 2, and 3 AFs). Multivariable competing risk Cox regression analyses were used to assess CSM. The study was performed in line with the Helsinki Declaration.

Results

Overall, 420 (68.2%) men had 1 AF, 156 (25.3%) had 2 AFs and 39 had 3 AFs (6.3%): among these different risk categories, significant differences in terms of preoperative and pathologic tumor characteristics, adjuvant therapies and biochemical recurrence were found (all p?0.01); overall, 44 (7.1%) of 615 patients died of PCa. Men with 1 AF had higher CSM-free survival estimates compared to those with 2 and 3 AFs (92.8% vs. 84.2% vs. 27.7% at 10 years’ follow-up, p<0.001 – Figure). At multivariate competing risk Cox regression analyses, the presence of 3 AFs (hazard ratio [HR]: 2.59), postoperative treatment status, namely adjuvant androgen deprivation therapy (aADT) alone/aADT plus adjuvant radiotherapy (aRT; HR: 2.44) and time to BCR (HR: 0.96), were all independent predictors of CSM (all p<0.04). In the subgroup of individuals referred to aADT alone, men with 2 AFs (HR: 3.11) and 3 AFs (HR: 5.14) had a higher risk of cancer-related death compared to those with 1 AF (all P?0.04).

Conclusions

The risk group stratification according to the number of AFs could help physicians to accurately predict oncologic outcomes selecting PCa patients for the most appropriate postoperative strategies. _x000D_

Funding

none