The Long-Term Clinical Impact of Biochemical Recurrence of Prostate Cancer 5 or More Years After Radical Prostatectomy

Ward, John F.; Blute, Michael L.; Slezak, Jeffrey M.; Bergstralh, Erik J.; Zincke, Horst

doi:10.1097/01.ju.0000091876.13656.2e

Cited by 218 publications

(141 citation statements)

References 21 publications

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“…Carver et al, 2006 reported on a population of men with T3 prostate cancer who underwent radical prostatectomy, only 36% with PSA biochemical failure had disease progression. Ward et al, 2003 found that in a population of 3897 radical prostatectomy patients, only 8.3% of the men with PSA biochemical failure died of prostate cancer. Thus PSA failure is associated with prostate cancer-specific death but the majority of men with PSA biochemical failure will die of other causes.…”

Section: Tmprss2:erg F Demichelis Et Almentioning

confidence: 99%

TMPRSS2:ERG gene fusion associated with lethal prostate cancer in a watchful waiting cohort

et al. 2007

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The identification of the TMPRSS2:ERG fusion in prostate cancer suggests that distinct molecular subtypes may define risk for disease progression. In surgical series, TMPRSS2:ERG fusion was identified in 50% of the tumors. Here, we report on a population-based cohort of men with localized prostate cancers followed by expectant (watchful waiting) therapy with 15% (17/111) TMPRSS2:ERG fusion. We identified a statistically significant association between TMPRSS2:ERG fusion and prostate cancer specific death (cumulative incidence ratio ¼ 2.7, Po0.01, 95% confidence interval ¼ 1.3-5.8).Quantitative reverse-transcription-polymerase chain reaction demonstrated high estrogen-regulated gene (ERG) expression to be associated with TMPRSS2:ERG fusion (Po0.005). These data suggest that TMPRSS2:ERG fusion prostate cancers may have a more aggressive phenotype, possibly mediated through increased ERG expression.

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Section: Tmprss2:erg F Demichelis Et Almentioning

confidence: 99%

TMPRSS2:ERG gene fusion associated with lethal prostate cancer in a watchful waiting cohort

et al. 2007

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“…The study population was not planned in advance, since this was a pilot study aiming to evaluate primarily the feasibility, safety, and morbidity profile of the technique. Moreover, the absence of an extended follow-up could be considered another limit since significant disease recurrence may occur with extended follow-up [24]. However, our outcomes could be used to design a prospective randomized trial, with adequate statistical power, comparing HIFU vs. SRT in the treatment of the palpable, local recurrence of CaP after RP.…”

Section: Discussionmentioning

confidence: 99%

HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: A pilot study

Asimakopoulos

Miano

Virgili

et al. 2012

Urologic Oncology: Seminars and Original Investigations

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Objective: To test high-intensity focused ultrasound (HIFU) as salvage first-line treatment for palpable, TRUS-evidenced, biopsyproven locally recurrent prostate cancer (CaP) after radical prostatectomy (RP). Materials and methods:Nineteen patients with palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP after RP, unwilling to undergo salvage radiotherapy (SRT), underwent HIFU as a single-session procedure. Pre-, intra-, and postoperative data including early and late complications, and oncologic outcomes (PSA nadir, biochemical recurrence (BCR)-free survival, and need of secondary adjuvant treatment) were prospectively evaluated. Success was defined as PSA nadir Յ0.1 ng/ml obtained within 3 months from HIFU. In case of PSA nadir Ͼ0.1 ng/ml or PSA increase Ն1 ng/ml above the PSA nadir, a biopsy of the treated lesion was performed, and if negative, maximum androgen blockade (MAB) was adopted. In case of positive biopsy, RT was performed. Failure was defined as use of secondary adjuvant treatment (MAB or RT).Results: Median follow-up was 48 months. All cases were performed as overnight procedure. No case of urethrorectal fistula or anastomotic stricture was observed. Two cases of acute urinary retention were resolved with prolonged urethral catheterization. Four cases of stress urinary incontinence were observed; 2 (mild incontinence) were resolved after pelvic floor exercises within 6 months, while 2 cases of severe incontinence required surgical minimally invasive treatment;17/19 patients (89,5%) were classified as success. Two patients failed to show a PSA nadir Ͻ0.1 ng/ml. During follow-up, 8/17 patients (47%) were classified as failure, with consequent total rate of failures 10/19 (52.6%). A statistically significant difference was observed in pre-HIFU median PSA (2 vs. 5.45 ng/ml, respectively, P ϭ 0.013) and Gleason score of the RP specimen (P ϭ 0.01) between the success and failure group.Conclusions: Salvage first-line HIFU for palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP is a feasible, minimally invasive day-case procedure, with an acceptable morbidity profile. It seems to have a good cancer control in the short-and mid-term. Patients with lower pre-HIFU PSA level and favorable pathologic Gleason score presented better oncologic outcomes. A prospective randomized trial with an adequate recruitment and follow-up is necessary to confirm our preliminary oncologic results.

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“…8,12,26,27 We did not find these factors to be significantly associated with death from prostate cancer in patients with a PSM, and in fact it is important to note that previous series correlated these features with BCR. Given the documented heterogeneous natural history of BCR, 16,18,19 we sought to identify the association of various clinicopathological features with SP and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…1,7,8,[10][11][12][13][14][15] Importantly, the use of BCR as a clinical outcome measure remains questionable, as the natural history of BCR is variable. That is, although approximately 35% of patients experience PSA failure within 10 years following RRP, 16,17 BCR does not always translate into systemic progression (SP) and prostate cancer death. 16,18,19 Furthermore, given the sensitivity of PSA to detect disease recurrence following RRP, the clinical course of patients with BCR is generally prolonged, and in fact, median survival has been found not to have reached 15 years after initial PSA failure in previous studies.…”

Section: Introductionmentioning

confidence: 99%

“…That is, although approximately 35% of patients experience PSA failure within 10 years following RRP, 16,17 BCR does not always translate into systemic progression (SP) and prostate cancer death. 16,18,19 Furthermore, given the sensitivity of PSA to detect disease recurrence following RRP, the clinical course of patients with BCR is generally prolonged, and in fact, median survival has been found not to have reached 15 years after initial PSA failure in previous studies. 18,19 Thus, as men with prostate cancer are generally over the age of 60, competing causes of mortality may obscure the ability of BCR to predict death from prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

Boorjian

Tollefson

Rangel

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND: Although a positive surgical margin (PSM) at radical prostatectomy (RRP) has been consistently linked to an increased risk of biochemical recurrence, the impact of margin status on patient survival continues to be debated. We evaluated long-term outcomes of patients with a PSM at RRP and determined predictors of systemic progression (SP) and mortality in these men. METHODS:We reviewed our institutional registry of 16 749 patients who underwent RRP between 1990 and 2008 to identify 2895 patients with a PSM. Median follow-up was 10.6 years. Postoperative survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze clinicopathological variables associated with SP and death from prostate cancer. RESULTS:A 15-year SP-free and cancer-specific survival was 90 and 93%, respectively. On multivariate analysis, higher tumor volume, increased pathological Gleason score and advanced pathological tumor stage were associated with significantly increased risks of SP and death from prostate cancer, whereas number and location of PSM did not predict mortality. CONCLUSIONS:The risks of SP and prostate cancer death in patients with a PSM remain low on long-term follow-up. Tumor variables are the primary determinants of cancer death. These results should be considered when evaluating patients with a PSM for adjuvant therapy.

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The Long-Term Clinical Impact of Biochemical Recurrence of Prostate Cancer 5 or More Years After Radical Prostatectomy

Abstract: Patients are at prolonged risk for BF and CF following RP. Regardless of the timing of the initial PSA recurrence the PSA doubling time is the most powerful predictor of progression, stratifying patients with BF into high and low risk groups for CF.

Cited by 218 publications

References 21 publications

TMPRSS2:ERG gene fusion associated with lethal prostate cancer in a watchful waiting cohort

TMPRSS2:ERG gene fusion associated with lethal prostate cancer in a watchful waiting cohort

HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: A pilot study

Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

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