Predictors of biochemical recurrence in pT3b prostate cancer after radical prostatectomy without adjuvant radiotherapy

Abstract

pT3b prostate cancer is a heterogeneous disease commonly associated with several high-risk features. Stratifying men with SVI by prognostic features (i.e., Gleason, PSA, node status, surgical margin status) and using these features to augment the CAPRA score will improve identification of those at higher risk for BCR that should be strongly considered for adjuvant XRT.

Long‐term utility of adjuvant hormonal and radiation therapy for patients with seminal vesicle invasion at radical prostatectomy

“…As prior series on SVI have been underpowered and offer conflicting recommendations on adjuvant therapy , in the present study we analysed the largest series of RP with SVI (3 279 patients) with the longest follow‐up (median follow‐up 148 months) to explore the utility of adjuvant therapies. We found that aRT was associated with improved survival with improvement in BCR (HR 0.83, P = 0.02), CSM (HR 0.69, P = 0.02) and OM (HR 0.85, P = 0.03) rates.…”

“…Lastly, our present analysis confirmed the importance of local margin control for patients with SVI by finding that PSMs were associated with increased risk of BCR (HR 1.32, P < 0.001), CSM (HR 1.37, P = 0.007), and OM (HR 1.20, P = 0.01). Other investigators have debated the importance of margin status in SVI: with most series finding a significant impact , while another recent report found no significant association . A recent review highlights the conflicting evidence about the impact of PSMs on concrete endpoints such as metastasis and survival .…”

“…Yet the SVI literature remains relatively scarce and contradictory regarding the utility of adjuvant therapies in terms of long‐term survivorship. For instance, series on SVI have largely been limited to 40–350 patients with median follow‐ups in the 2–10 year range and have succeeded only in confirming the disease heterogeneity for pT3b prostate cancer . Some of these investigations have supported aRT , while another supported aHT + aRT , and yet others supported forgoing aRT all together .…”

“…For instance, series on SVI have largely been limited to 40–350 patients with median follow‐ups in the 2–10 year range and have succeeded only in confirming the disease heterogeneity for pT3b prostate cancer . Some of these investigations have supported aRT , while another supported aHT + aRT , and yet others supported forgoing aRT all together . When members of our own group have examined the topic of SVI , they found aHT to be associated with improved metastasis and cancer‐specific survival but not overall survival.…”

Prognostic value of seminal vesicle invasion on preoperative multi-parametric magnetic resonance imaging in pathological stage T3b prostate cancer

“…BCR, biochemical recurrence; BMI, body mass index; GS, Gleason score; LNI, lymph node invasion; MRI, magnetic resonance imaging; PSA, prostate-specific antigen; PSM, positive surgical margin; RP, radical prostatectomy; SVI, seminal vesicle invasion. (2020) 10:5693 | https://doi.org/10.1038/s41598-020-62808-z www.nature.com/scientificreports www.nature.com/scientificreports/ and LNI, SVI has also been found to be independently associated with a poor prognosis [24][25][26][27] . However, the five-year BCR rates for patients with SVI were extremely variable, ranging from 8% to 68%.…”