Prognostic factors identified for prostatectomy outcome in high grade cancer

NEW YORK (Reuters Health) – Researchers from the Mayo Clinic, Rochester, Minnesota, have identified independent predictors of 10-year progression-free survival after radical prostatectomy in men with Gleason 8 prostate cancer or higher. Similar to predictors for other grades, these factors include tumor grade and stage, preoperative prostate specific antigen (PSA), and adjuvant therapy.

In a retrospective analysis, Dr. Horst Zincke and colleagues collected data on 407 men who had Gleason 8 disease or higher and underwent radical prostatectomy, according to their report in the January issue of The Journal of Urology.

At 5 years after radical prostatectomy the crude overall survival among these men was 87%, with 93% for cancer specific survival. At 10 years, the corresponding rates were 66% and 85%, the researchers found.

Ten-year progression-free survival for men who received adjuvant therapy was 52% compared with 23% for men who did not receive adjuvant therapy, they add.

Multivariate analysis revealed that pathological grade (p < 0.021), pathological stage (p < 0.036), preoperative PSA (p < 0.0001), and adjuvant therapy (p < 0.0001) were significant independent predictors of 10-year progression-free survival.

"Although adjuvant therapy appears to have reduced disease progression in our nonrandomized study, it did not significantly reduce death from prostate cancer in 10 years," the Mayo team says.

Dr. Zincke and colleagues conclude that "in the patients with high grade organ-confined disease PSA appeared to be useful for identifying those at highest risk for disease progression. Large, randomized prospective studies will be required to properly evaluate adjuvant systemic therapy regimens."

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