Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin – A multicenter study

• Published in: Radiotherapy and oncology Vol. 116; no. 1; pp. 119 - 124
• Main Authors: Karl, Alexander, Buchner, Alexander, Tympner, Christiane, Kirchner, Thomas, Ganswindt, Ute, Belka, Claus, Ganzer, Roman, Wieland, Wolf, Eder, Fabian, Hofstädter, Ferdinand, Schilling, David, Sievert, Karl-Dietrich, Stenzl, Arnulf, Scharpf, Marcus, Fend, Falko, vom Dorp, Frank, Rübben, Herbert, Schmid, Kurt Werner, Porres-Knoblauch, Daniel, Heidenreich, Axel, Hangarter, Birgit, Knüchel-Clarke, Ruth, Rogenhofer, Michael, Wullich, Bernd, Hartmann, Arndt, Comploj, Evi, Pycha, Armin, Hanspeter, Esther, Pehrke, Dirk, Sauter, Guido, Graefen, Markus, Gratzke, Christian, Stief, Christian, Wiegel, Thomas, Haese, Alexander
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.07.2015
• Subjects: Adjuvant therapy; Adult; Aged; Hematology, Oncology and Palliative Medicine; Humans; Localized prostate cancer; Lymph Node Excision; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Prognostic parameters; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Recurrence; Retrospective Studies; Risk; Salvage Therapy; Surgical margins; Survival Rate; Surgical margins; Localized prostate cancer; Adjuvant therapy; Prognostic parameters
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2015.06.021

Abstract Background and purpose Positive surgical margins (PSM) after radical prostatectomy have been shown to be associated with impaired outcome. In pT3pN0 patients with PSM either immediate radiotherapy or clinical and biological monitoring followed by salvage radiotherapy is recommended by the latest guidelines of the European Association of Urology. Materials and methods A retrospective, multicenter study of eight urological centers was conducted on 536 prostatectomy patients with pT3aN0/NxR1 tumors and no neoadjuvant/adjuvant therapy. A pathological re-review of all prostate specimens was performed. Association of clinical and pathological features with biochemical recurrence (BCR) was analyzed using univariate and multivariate analysis. Results With 48 months median follow-up, BCR occurred in 39.7%. Preoperative PSA value, performance of pelvic lymph node dissection and Gleason score were significantly associated with BCR. In multivariate analysis, Gleason score was the only independent prognostic factor ( p < 0.001) for BCR. Five-year BCR-free survival rates were 74%, 70%, 38%, and 51% with Gleason score 6, 3 + 4 = 7a, 4 + 3 = 7b, and 8–10, respectively. Conclusions In pT3aN0/NxR1 patients with no adjuvant/neoadjuvant treatment, Gleason Score permits independent prediction of the risk for BCR. These findings could help to estimate and discuss the individual risk for BCR with our patients on an individual basis.