Pathological outcomes and biochemical recurrence-free survival after radical prostatectomy for high-risk prostate cancer in the Indian population

Abstract

Introduction:We analyzed the biochemical recurrence-free survival (BRFS) of patients with high-risk prostate cancer (HRCaP) as per the D’Amico classification undergoing radical prostatectomy (RP) at our center. We aimed to determine whether the number and type of risk factors (cT2c-T3b, prostate-specific antigen >20 ng/ml, Gleason score >7) are associated with biochemical recurrence (BCR) in HRCaP patients undergoing RP in the Indian population.Methods:Between 2006 and 2017, 192 patients underwent RP (open RP [ORP], laparoscopic RP [LRP], and robotic RP [RRP]) at our center, of which 109 had D’Amico HR disease. Preoperative, postoperative, and pathological outcome data were analyzed for patients with HR disease as per the D’Amico classification. Subgroups were formed to determine whether an increasing number of risk factors (1, 2, or 3) were associated with poorer oncological results and early BCR. The Kaplan–Meier method with log-rank test was used to test the difference in BRFS between the groups. Univariate and multivariate analyses were done to find significant variable against BCR.Results:According to the D’Amico criteria, 109 patients had HR, 63 patients had intermediate-risk, and 19 patients had low-risk disease. These 109 patients with HR disease were analyzed in our study (50 RRP, 33 ORP, and 26 LRP). A total of 59 (54.1%) patients had one HR factor (1HR), 44 (40%) had two HR factors (2HR), and 6 (5.5%) had three HR factors (3HR). The mean follow-up for our patient population was 21.5 ± 19 months (median 18 months; range, 0–108). Overall, the 2-year and 5-year BRFS was 45% and 35%, respectively (mean BRFS 46 ± 6 months). Two-year BRFS was 63%, 23%, and 22%, respectively, for 1HR, 2HR, and 3HR (logrank, P < 0.0001). The prognostic substratification based on the three risk factors was significantly predictive for adverse pathologic features and oncologic outcomes.Conclusion:Substratification based on the three well-defined criteria leads to a better identification of the more aggressive cancers and prediction of need for additional treatment modalities. Localized HRCaP includes a heterogeneous population of patients with variable oncological outcomes.

Short Term Outcomes in Indian Patients with High Risk Prostate Cancer after Laparoscopic Radical Prostatectomy- Data from a Single Institute

“…Our blood transfusion rate (12.9%) was similar to the rate reported by Varca V et al (11.8%) [11]. Grade IIIa and IIIb complications occurred in 3.5% and 3.6% of the cases in our study, respectively; which were comparable to the findings of Varca V et al [11,15,19]. We didn't encounter any grade IV complication.…”

“…Similarly the distribution of biopsy GS was variable. A score below 8 in more than half of the cases was reported by few authors [11,14,16,18,19]; while a score of 8 or more was noted by others, including us [5,10,17]. However, patient's clinical stage in our study was similar to the other reports.…”

“…PSA distribution among the various other studies of HRPC treatment by RP was not uniform ( Table 5). Mean PSA around 10ng/ml was found in a few studies [7,10,14,15,16,17] while a value between 15-25ng/ml was observed in others, including in our study [5,11,18,19]. Similarly the distribution of biopsy GS was variable.…”

“…Postoperative urinary continence in terms of no pad use was observed in 89.3% of our patients after 12 months. Varca V et al and Bijalwan P et al reported a slightly lower continence rate of 81.8% and 79.8%, respectively [11,19]; while Benedetto A et al found the similar outcome (91.8%) [15]. As we performed a non-nerve sparing approach, the postoperative potency rate was not assessed.…”

What's inside

“…Bijalwan et al . [ 5 ] looked at the outcome of radical prostatectomy in high-risk prostate cancer in Indian patients. With a mean follow-up of 21 months, the 2- and 5-year biochemical recurrence-free survival (BRFS) was 45% and 35%.…”