Emerging evidence has suggested that cytoreductive prostatectomy （CRP） allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit ...Emerging evidence has suggested that cytoreductive prostatectomy （CRP） allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer （mPCa） has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer （PCa）. Urinary incontinence was defined as the use of any pad. CRP had longer operative times （200 min vs 140 min, P 〈 0.0001） and higher estimated blood loss （250 ml vs 125 ml, P 〈 0.0001） compared to the control group. However, both overall （8.82% vs 5.85%） and major complication rates （4.41% vs 2.17%） were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group （57.4% vs 90.8%, P 〈 0.0001）. Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model （OR： 1.18; 95% Ch 1.02-1.37; P= 0.025） and surgery type-adjusted model （OR： 1.17; 95% Ch 1.01-1.36; P= 0.034）. In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.展开更多
Recently, it has been suggested that the guideline for adjuvant radiotherapy （ART） following radical prostatectomy （RP） sponsored by the American Urological Association and American Society for Radiation Oncology ...Recently, it has been suggested that the guideline for adjuvant radiotherapy （ART） following radical prostatectomy （RP） sponsored by the American Urological Association and American Society for Radiation Oncology （AUA/ASTRO） may result in a significant overtreatment. Thus, the objective of the present study was to refine the AUA/ASTRO guideline for ART in patients at risk for biochemical recurrence （BCR） after RP. To this end, we reviewed our prospectively maintained database and selected 193 patients who met the AUA/ASTRO ART criteria. With a median follow-up of 24.0 months, BCR rate was 17.6% （34/193）. When stratified by the Gleason score, BCR rate in men with Gleason score 6 was 6.8%. There was no significant association between BCR-free survival and surgical margin （P= 0.690） and pathologic stage （P= 0.353） in patients with the Gleason score 6. However, in patients with positive surgical margins （PSMs）/pathologic stage ≥T3, there was a significant difference in BCR-free survival according to Gleason score （≤7 vs8-10, P= 0.047）. Multivariate Cox regression analysis demonstrated that pathologic stage ≥T3 （HR = 2.106; P = 0.018）, PSMs （HR = 2.411; P = 0.003）, and pathologic Gleason score 8-10 （HR = 4.715; P 〈 0.001） were independent predictors of BCR after RP. Therefore, in addition to pathologic stage 〉T3 and PSMs, Gleason score 8-10 predicts 8CR after RP. In patients with Gleason score 6, observation rather than ART may be more appropriate regardless of stage and surgical margin status.展开更多
The aim of this study is to identify optimal patients for adjuvant radiation therapy （ART） in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy （RP） has...The aim of this study is to identify optimal patients for adjuvant radiation therapy （ART） in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy （RP） has been demonstrated, but over- or under-treatment remains a significant concern. Two-hundred and five patients with pT3NOMO who underwent robot-assisted RP without ART were analyzed. Multivariate Cox proportional regression analyses were used to identify predictors of biochemical recurrence （BCR） and clinical progression （CP）. The estimated 5-year BCR-free survival （BCRFS） and CP-free survival （CPFS） were 52.8% and 85.6%, respectively. Preoperative prostate-specifc antigen （PSA） ：〉10 ng m1-1 （hazard ratio [HR]： 3.288-6.027; P = 0.003）, pathologic Gleason score （pGS） ：〉8 （HR： 4.146; P = 0.014）, and lymphovascular invasion （LVI） （HR： 2.167; P = 0.026） were associated with BCR. Based on these factors, a risk stratification tool was developed. Patients with no risk factors （PSA 〈10 ng m1-1, pGS 6, and absent LVI） showed excellent BCRFS and CPFS at 5 years （91.9% and 100.0%, respectively）, but those with two or more risk factors （PSA ：〉10 ng ml-1, pGS ≥8, or present LVI） had poor BCRFS and CPFS （12.1% and 54.6%, respectively）. In addition, the multivariate analysis revealed that pathologic stage pT3b （HR： 5.393; P = 0.025） was the only predictor of CP. Our study demonstrated the heterogeneity of oncologic outcomes in patients with pT3 prostate cancer. The proposed risk stratification can be used to identify patients who are at risk for disease progression and may aid in identifying the best patients for ART.展开更多
文摘Emerging evidence has suggested that cytoreductive prostatectomy （CRP） allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer （mPCa） has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer （PCa）. Urinary incontinence was defined as the use of any pad. CRP had longer operative times （200 min vs 140 min, P 〈 0.0001） and higher estimated blood loss （250 ml vs 125 ml, P 〈 0.0001） compared to the control group. However, both overall （8.82% vs 5.85%） and major complication rates （4.41% vs 2.17%） were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group （57.4% vs 90.8%, P 〈 0.0001）. Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model （OR： 1.18; 95% Ch 1.02-1.37; P= 0.025） and surgery type-adjusted model （OR： 1.17; 95% Ch 1.01-1.36; P= 0.034）. In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.
文摘Recently, it has been suggested that the guideline for adjuvant radiotherapy （ART） following radical prostatectomy （RP） sponsored by the American Urological Association and American Society for Radiation Oncology （AUA/ASTRO） may result in a significant overtreatment. Thus, the objective of the present study was to refine the AUA/ASTRO guideline for ART in patients at risk for biochemical recurrence （BCR） after RP. To this end, we reviewed our prospectively maintained database and selected 193 patients who met the AUA/ASTRO ART criteria. With a median follow-up of 24.0 months, BCR rate was 17.6% （34/193）. When stratified by the Gleason score, BCR rate in men with Gleason score 6 was 6.8%. There was no significant association between BCR-free survival and surgical margin （P= 0.690） and pathologic stage （P= 0.353） in patients with the Gleason score 6. However, in patients with positive surgical margins （PSMs）/pathologic stage ≥T3, there was a significant difference in BCR-free survival according to Gleason score （≤7 vs8-10, P= 0.047）. Multivariate Cox regression analysis demonstrated that pathologic stage ≥T3 （HR = 2.106; P = 0.018）, PSMs （HR = 2.411; P = 0.003）, and pathologic Gleason score 8-10 （HR = 4.715; P 〈 0.001） were independent predictors of BCR after RP. Therefore, in addition to pathologic stage 〉T3 and PSMs, Gleason score 8-10 predicts 8CR after RP. In patients with Gleason score 6, observation rather than ART may be more appropriate regardless of stage and surgical margin status.
文摘The aim of this study is to identify optimal patients for adjuvant radiation therapy （ART） in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy （RP） has been demonstrated, but over- or under-treatment remains a significant concern. Two-hundred and five patients with pT3NOMO who underwent robot-assisted RP without ART were analyzed. Multivariate Cox proportional regression analyses were used to identify predictors of biochemical recurrence （BCR） and clinical progression （CP）. The estimated 5-year BCR-free survival （BCRFS） and CP-free survival （CPFS） were 52.8% and 85.6%, respectively. Preoperative prostate-specifc antigen （PSA） ：〉10 ng m1-1 （hazard ratio [HR]： 3.288-6.027; P = 0.003）, pathologic Gleason score （pGS） ：〉8 （HR： 4.146; P = 0.014）, and lymphovascular invasion （LVI） （HR： 2.167; P = 0.026） were associated with BCR. Based on these factors, a risk stratification tool was developed. Patients with no risk factors （PSA 〈10 ng m1-1, pGS 6, and absent LVI） showed excellent BCRFS and CPFS at 5 years （91.9% and 100.0%, respectively）, but those with two or more risk factors （PSA ：〉10 ng ml-1, pGS ≥8, or present LVI） had poor BCRFS and CPFS （12.1% and 54.6%, respectively）. In addition, the multivariate analysis revealed that pathologic stage pT3b （HR： 5.393; P = 0.025） was the only predictor of CP. Our study demonstrated the heterogeneity of oncologic outcomes in patients with pT3 prostate cancer. The proposed risk stratification can be used to identify patients who are at risk for disease progression and may aid in identifying the best patients for ART.
