Introduction

To validate the current NCCN-classification of very high-risk (VHR) patients and compare the pathological, functional and oncological outcomes between surgically treated high- (HR) and VHR patients.

Methods

We retrospectively analyzed 4041 patients stratified into HR or VHR who underwent RP between 1992 and 2016. Multivariable logistic regression and Kaplan-Meier survival analyses compared outcomes between the two groups.

Results

After RP, the rate of adverse pathological features was higher in 1369 VHR vs. 2672 HR patients. Functional outcomes were similar between both groups, with 1-year continence (UC) and potency rates of 83.5% and 59.5% in the VHR compared to 82.7% and 42% in the HR group (p = 0.8 and p = 0.1). Accordingly, no difference was found in multivariate logistic regression predicting UC at three and twelve months after RP. In a subset of 1835 patients who underwent RP between 1992-2011 (median follow-up 58.8 months), VHR patients had significantly worse five- and eight-year biochemical recurrence-free survival (BFS), metastatic progression- free survival (MP-FS), prostate cancer-specific mortality-free survival (PCSM-FS) and overall survival (OS) rates. Eight-year BFS and MP-FS rates were 25.4% and 71.5% for VHR vs. 43.1% and 86.1% for HR patients. For the same time point, PCSM-FS and OS rates were 87% and 76.1% for VHR vs. 93.2% and 83.7% for HR patients, respectively (all p < 0.001).

Conclusions

Despite the relatively poor prognosis of HR PCa patients, RP provides favorable five- and eight-year MP, PCSM and OM-free survival rates. Relative to HR patients, their VHR counterparts harbor significantly worse pathological and oncological outcomes and more frequently require additional therapies. These observations validate the stratification between HR and VHR in European PCa patients. Interestingly, functional outcomes are similar between the two groups.

Funding

none