PSA at postoperative three months can predict biochemical recurrence in patients with pathological T3 prostate cancer following radical prostatectomy

Abstract

Objectives: To identify the prognostic factors and determine which pT3 prostate cancer patients can be safely followed up after surgery without any adjuvant treatment. Methods: A retrospective review was carried out on 106 patients with pT3 prostate cancer. All preoperative and postoperative parameters, including the postoperative serum prostate-specific antigen (PSA) level at 3 months after surgery, were assessed by univariate and multivariate analyses. Results: Mean follow-up period was 18 months. The overall biochemical recurrence-free rate was 53.7% and 34.1% at 12 and 36 months, respectively. On univariate analysis, all preoperative clinical factors were significantly correlated with biochemical progression. On multivariate analysis, pathological Gleason score, pathological stage and postoperative PSA were significant predictors. Among those with undetectable PSA after surgery, 38 patients (88.4% of 43) did not have disease progression during the follow-up period. On the other hand , of the 27 patients with detectable PSA that was not defined as progressive (range 0.01-0.20), 22 (81.5%) had biochemical disease progression. The progression free probability was significantly different between these two groups (P-value < 0.0001). Conclusions: pT3 prostate cancer patients showing low pathological Gleason score, without seminal vesicle invasion, and undetectable postoperative PSA values have low probability of PSA progression. Careful follow up including periodic PSA assessment and clinical observation represents an adequate strategy in the management of these patients.

Long-term results of radical prostatectomy with immediate adjuvant androgen deprivation therapy for pT3N0 prostate cancer

“…Interestingly, no patients with clinical T1 tumors (n = 20), negative surgical margin (n = 12), or negative perineural invasion (n = 11) experienced hormone-refractory biochemical progression. In partial agreement with our results, previous studies identified Gleason score, PSA, seminal vesicle invasion and lymphovascular invasion as prognostic predictors in patients with pT3N0 stage prostate cancer undergoing radical prostatectomy [10-13]. …”

“…In a previous study, Inagaki et al reported 1- and 3-year biochemical progression-free survival rates of 53.7 and 34.1% in 106 patients with pT3N0M0 prostate cancer treated with radical prostatectomy alone, after a mean follow-up of 1.5 years [10]. Delongchamps et al and Briganti et al reported 5-year biochemical progression-free survival rates of 48 and 45.0% in 147 and 500 patients with pT3N0M0 prostate cancer, respectively, treated with radical prostatectomy alone, after median follow-up periods of 5 and 3.9 years [11,12].…”

“…Although the management of patients with pT3 prostate cancer remains controversial, some reports recommend the use of adjuvant therapies in these patients [5-9]. Few studies have reported treatment outcomes of pT3 cancers, but some clinicopathologic factors, such as higher Gleason score, higher PSA level and seminal vesicle invasion are considered to be prognostic factors associated with poorer outcome [10-13]. However, to the best of our knowledge, there have been few reports of pT3N0 patients treated with adjuvant hormonal therapy, and more outcome data and accurate information are needed for these patients.…”

Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

“…Inagaki et al . reported a no-pSM rate of 38.7% for 106 cases of pT3a and pT3b that had been diagnosed as cT1 and cT2 preoperatively [14], and Kordon et al also reported that the incidence of no pSM in 288 pT3a cases was 52.1% [20], which is much lower than the respective 82.1% and 85.7% values seen in our series.…”

“…Even though the efficacy of cancer treatment should be evaluated by cause-specific survival, we used the achievement of undetectable PSA, which has been reported as a significant predictor of biochemical recurrence (BCR) in pT3 cases after surgery by multivariate analysis [14], and BCF-free survival as surrogate endpoints because the natural history of prostate cancer is very long and PSA is extremely sensitive. The date of BCR was defined as the time at which the serum PSA level exceeded 0.2 ng/ml after surgery.…”