Disease Recurrence and Progression in Untreated Pathologic Stage T3 Prostate Cancer: Selecting the Patient for Adjuvant Therapy

Lowe, Bruce A.; Lieberman, Stephen F.

doi:10.1016/s0022-5347(01)64240-x

Cited by 80 publications

(42 citation statements)

References 19 publications

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“…Similar to previous reports, we did not observe a higher risk for disease recurrence if multiple positive margins were present (1,14). In contrast, Lowe and Lieberman reported that the number of positive margins had an important impact on disease recurrence (15).…”

Section: Discussionsupporting

confidence: 90%

Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Objective: Histological details of positive surgical margins in radical prostatectomy specimens have been related to outcome after surgery in rare studies recently published. Our objective is to assess whether the status of surgical margins, the extent and the Gleason score of positive margins, and the extent of the extraprostatic extension are predictive of biochemical recurrence post-radical prostatectomy. Materials and Methods:Three hundred sixty-five radical prostatectomy specimens were analyzed. The length of the positive surgical margin and extraprostatic extension and the Gleason score of the margin were recorded. Statistical analyses examined the predictive value of these variables for biochemical recurrence.Results: 236 patients were stage pT2R0, 58 pT2R1, 25 pT3R0 and 46 pT3R1. Biochemical recurrence occurred in 11%, 31%, 20% and 45.7% of pT2R0, pT2R1, pT3R0 and pT3R1, respectively. The extent of the positive surgical margins and the Gleason score of the positive surgical margins were not associated with biochemical recurrence in univariate analysis in a mean follow up period of 35.9 months. In multivariate analyses, only the status of the surgical margins and the global Gleason score were associated with biochemical recurrence, with a risk of recurrence of 3.1 for positive surgical margins and of 3.8 for a Gleason score > 7. Conclusion: Positive surgical margin and the global Gleason score are significant risk factors for biochemical recurrence post-radical prostatectomy, regardless of the extent of the surgical margin, the extent of the extraprostatic extension, or the local Gleason score of the positive surgical margin or extraprostatic tissue. pT2R1 disease behaves as pT3R0 and should be treated similarly.

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Section: Discussionsupporting

confidence: 90%

Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a

et al. 2014

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“…14, 15 Lowe et al found that men with more than one positive margins were at increased risk of recurrence in univariate analysis. 14 However, no multivariate analysis was performed. In the current study, the number of positive margins remained a significant predictor of recurrence on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification for Biochemical Recurrence in Men With Positive Surgical Margins or Extracapsular Disease After Radical Prostatectomy: Results From the SEARCH Database

et al. 2008

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Purpose-Among men with either extracapsular disease or positive surgical margins after radical prostatectomy, immediate adjuvant therapy decreases the risk of biochemical recurrence at the cost of increased toxicity. We sought to further stratify these men into a low-risk group in whom watchful waiting after surgery may be preferred and a high-risk cohort in whom adjuvant therapy may be preferred. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Materials and Methods-We NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptCox proportional hazards regression model, we generated tables to estimate the risk of recurrence at 1, 3 and 5 years after surgery.Results-After a median of 3 years of follow-up, 346 (39%) patients developed a biochemical recurrence. On multivariate analysis, the significant predictors of biochemical recurrence included age >60 years, PSA >10 ng/ml, Gleason score 4+3 and 8-10, 2 or more sites of positive surgical margins and prostate specimen weight ≤30 grams. The overall predictive accuracy of the model as determined by the Concordance Index C was 0.67, which compared to 0.60 for the post-operative "Kattan nomogram" for this patient population.Conclusions-We have developed a simple instrument, which once validated, may aid in the postoperative decision making process for men with intermediate risk of recurrence after prostatectomy.

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“…For example, (66,77) patients with multiple margins had a higher risk of failure (44%,27%) than those with a s i n g l e m a r g i n ( 2 1 % , 1 5 % ) . O t h e r s t u d i e s h a v e r eported similar findings (30,53,67), although it is not always an independent predictive factor on multivariate analysis.…”

Section: Which Probably Acc O U N T S F O R S O M E O F T H E V a Rmentioning

confidence: 99%

Prognostic Factors for Failure after Prostatectomy

Swanson¹,

Basler²

2011

J. Cancer

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Disease Recurrence and Progression in Untreated Pathologic Stage T3 Prostate Cancer: Selecting the Patient for Adjuvant Therapy

Abstract: The majority of patients with pT3 prostate cancer will not experience recurrent disease for many years if ever. Immediate use of adjuvant treatment should be reserved for those patients with a high risk of recurrent disease.

Cited by 80 publications

References 19 publications

Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a

Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a

Risk Stratification for Biochemical Recurrence in Men With Positive Surgical Margins or Extracapsular Disease After Radical Prostatectomy: Results From the SEARCH Database

Prognostic Factors for Failure after Prostatectomy

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