Patients treated with radical prostatectomy with positive digital rectal examination findings in the intermediate-risk group are prone to PSA recurrence

Abstract

Abstract. The present study aimed to evaluate the possibility of performing radical prostatectomy (RP) alone to achieve a radical cure for prostate cancer in the intermediate-risk group. Samples were collected from 638 Japanese patients who underwent antegrade RP between August 1998 and May 2013; subsequently, 157 patients were excluded. According to the D' Amico criteria, the low-, intermediate-and high-risk groups comprised 107, 222 and 152 patients, respectively. The 5-year prostate-specific antigen (PSA) failure-free survival rates in the low-, intermediate-, and high-risk groups were 96.5, 88.9 and 72.6%, respectively (P<0.001; degrees of freedom=2). In the intermediate-risk group, the difference in PSA failure-free survival between the 0<PSA≤10 and 10<PSA≤20 ng/ml, and the biopsy Gleason score 6 and 7 groups were not statistically significant, according to the log-rank test (P=0.2266 and P=0.1329, respectively). However, the difference in PSA failure-free survival between the clinical tumor stage (cT)1c and cT2a/b groups was statistically significant based on the log-rank test (P<0.0001). The results of the multivariate analysis revealed that, of the preoperative characteristics, only the cT was a significant predictor in patients with and without PSA failure (P<0.001). Therefore, patients classified into the intermediate-risk group with cT2a/b stage, according to positive digital rectal examination findings, and are not considered to be likely to achieve a complete cure with RP surgery alone. In summary, for patients meeting these criteria in the intermediate-risk group, RP surgery alone is likely to be insufficient, and other additional treatments may be considered subsequent to RP.

Mortality reduction and cumulative excess incidence (CEI) in the prostate-specific antigen (PSA) screening era

“…At this early stage, prognosis of aggressive cancers is better with treatment 25 . Similarly, a surgical series noted prostate cancer cure rates of approximately 90% in absence of palpable disease and 20% with a palpable nodule 26 . Thus, there are many sources of data that do not support the argument that mortality reduction in the context of PSA mass utilization can be completely explained by improved treatment.…”

O papel dos marcadores MMP-9, TIMP-1, RECK e miR-338-3p no diagnóstico e prognóstico do câncer de próstata

“…Em uma análise retrospectiva, onde foram avaliados pacientes submetidos a PTR como forma de tratamento para o câncer de próstata, foi observado que os pacientes com riscos baixo, intermediário e alto apresentaram taxas de sobrevida livre de recidiva bioquímica em cinco anos de 96,5, 88,9 e 72,6%, respectivamente. Dentre os pacientes de risco intermediário, apenas o TR alterado foi fator de risco para recidiva bioquímica (34) .…”