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Clinical Research

Outcomes of extremely low risk prostate cancer following radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 14, pages 266–269 (2011)Cite this article

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Abstract

The optimal management of men with very favorable clinicopathological factors who develop biochemical recurrence (BCR) after radical prostatectomy (RP) has not been previously reported. Both local and systemic recurrences are unlikely in this cohort. This study examines their management and outcomes. Between October 2000 to March 2010, 1627 men underwent open RP by a single surgeon. In all, 448 (27.5%) met the following criteria for extremely low risk disease: preoperative PSA level <10 ng ml−1, clinical stage T1c/T2a, Gleason score ⩽6, estimated cancer volume in the surgical specimen ⩽5% and no evidence for positive surgical margin. Undetectable PSA was defined as ⩽0.04 ng ml−1. BCR was defined as PSA ⩾0.2 ng ml−1 or initiation of salvage radiation therapy (SRT) for progressively rising PSA. At 54 months mean follow-up (range 3–114 months), 9 (2%) of the 448 men developed BCR. Mean time to BCR was 63 months (range 12–93) and mean PSA doubling time was 15 months (range 6–27). Six underwent SRT, two elected surveillance and one was lost to follow-up. All men undergoing SRT exhibited more than 75% reduction in pre-SRT PSA, indicating the presence of local disease recurrence. All men undergoing SRT maintained PSA levels <0.1 at last follow-up. The BCR of 2% confirmed that we selected a cohort with extremely low risk for BCR after RP. We demonstrated that men fulfilling our criteria who develop BCR all harbor local disease based on favorable response to SRT. These men should be managed with SRT if recurrence is felt to be biologically significant.

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References

  1. Pound CR, Partin AW, Epstein JI, Walsh PC . Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urol Clin North Am 1997; 24: 395–406.

    Article  CAS  PubMed  Google Scholar 

  2. Zincke H, Oesterling JE, Blute ML, Bergstralh EJ, Myers RP, Barret DM . Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol 1994; 152: 1850–1857.

    Article  CAS  PubMed  Google Scholar 

  3. Makarov DV, Trock BJ, Humphreys EB, Mangold LA, Walsh PC, Epstein JI et al. Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology 2007; 69: 1095–1101.

    Article  PubMed  Google Scholar 

  4. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280: 969–974.

    Article  PubMed  Google Scholar 

  5. Stephenson AJ, Scardino PT, Eastham JA, Bianco Jr FJ, Dotan ZA, DiBlasio CJ et al. Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 2005; 23: 7005–7012.

    Article  PubMed  Google Scholar 

  6. Rampersaud EN, Sun L, Moul JW, Madden J, Freedland SJ . Percent tumor involvement and risk of biochemical progression after radical prostatectomy. J Urol 2008; 180: 571–675.

    Article  PubMed  Google Scholar 

  7. Lepor H . Radical retropubic prostatectomy. Urol Clin North Am 2001; 28: 509–519, vii.

    Article  CAS  PubMed  Google Scholar 

  8. Bostwick DG, Foster CS . Pathology of the Prostate. WB Saunders: Philadelphia, 1998.

    Google Scholar 

  9. Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC . Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281: 1591–1597.

    Article  CAS  PubMed  Google Scholar 

  10. D’Amico AV, Whittington R, Malkowicz SB, Weinstein M, Tomaszewski JE, Schultz D et al. Predicting prostate specific antigen outcome preoperatively in the prostate specific antigen era. J Urol 2001; 166: 2185–2188.

    Article  PubMed  Google Scholar 

  11. Lieberfarb ME, Schultz D, Whittington R, Malkowicz B, Tomaszewski JE, Weinstein M et al. Using PSA, biopsy gleason score, clinical stage, and the percentage of positive biopsies to identify the optimal candidates for prostate-only radiation therapy. Int J Radiat Oncol Biol Phys 2002; 53: 898–903.

    Article  PubMed  Google Scholar 

  12. Ramos CG, Roehl KA, Antenor JAV, Humphrey PA, Catalona WJ . Percent carcinoma in prostatectomy specimen is associated with risk of recurrence after radical prostatectomy in patients with pathologically organ confined prostate cancer. J Urol 2004; 172: 137–140.

    Article  PubMed  Google Scholar 

  13. Nelson BA, Shappell SB, Chang SS, Wells N, Farnham SB, Smith JA et al. Tumour volume is an independent predictor of prostate-specific antigen recurrence in patients undergoing radical prostatectomy for clinically localized prostate cancer. BJU Int 2006; 97: 1169–1172.

    Article  PubMed  Google Scholar 

  14. Perlmutter MA, Lepor H . Prostate-specific antigen doubling time is a reliable predictor of imageable metastases in men with biochemical recurrence after radical retropubic prostatectomy. Urology 2008; 72: 501–505.

    Article  Google Scholar 

  15. Hernandez DJ, Nielsen ME, Han M, Trock BJ, Partin AW, Walsh PC et al. Natural history of pathologically organ-confined (pT2), gleason score 6 or less, prostate cancer after radical prostatectomy. Urology 2008; 72: 172–176.

    Article  PubMed  Google Scholar 

  16. Godoy G, Tareen BU, Lepor H . Does benign prostatic tissue contribute to measureable PSA levels after radical prostatectomy? Urology 2009; 74: 167–170.

    Article  PubMed  Google Scholar 

  17. Penson DF, Chan JM . Urologic diseases in america project prostate cancer. J Urol 2007; 177: 2020–2029.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, New York University School of Medicine, New York, NY, USA

    E W Lee, J Laze & H Lepor

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  1. E W Lee
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  2. J Laze
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Correspondence to H Lepor.

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Competing interests

Dr Lepor is the co-owner of Medreviews. He is an investor and consultant for Serenity and USHIFU. He has also consulted for Watson and Quanterix. All the other authors declare no conflict of interest.

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Lee, E., Laze, J. & Lepor, H. Outcomes of extremely low risk prostate cancer following radical prostatectomy. Prostate Cancer Prostatic Dis 14, 266–269 (2011). https://doi.org/10.1038/pcan.2011.21

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