Prognosis of men with high-risk prostate cancer stratified by risk factors: A population-based retrospective cohort study

Abstract

Objective: To evaluate the prognosis of men with high-risk prostate cancers (PCa) stratified by high-risk factors.Methods: Men with localized high-risk PCa were identified from 2004 to 2015. Kaplan–Meier analysis and Cox regressions were adopted to evaluate prostate cancer-specific survival (PCSS). Results: A total of 151,799 patients were included. Seven risk groups were divided including one high-risk factor of T3-4 (A1), prostate-specific antigen (PSA) >20 ng/ml (A2), and Gleason score (GS) 8-10, two high-risk factors of T3-4 PSA>20 ng/ml (B1), T3-4 GS 8-10 (B2), PSA>20 ng/ml GS 8-10 (B3), and three high-risk factors of T3-4 PSA>20 ng/ml and GS 8-10 (C). The PCSS results showed that A1 was the best among all groups. A2, A3 and B1 were similar and were all better than B2. No significant difference existed between B3 and C and these two were the worst in prognosis. The 10-year PCSS rates of A1, A2, A3, B1, B2, B3, and C group were 95.8%, 86.9%, 86.1%, 86.9%, 80.8%, 64.7% and 65.6%, respectively. Three simplified groups were divided including a good prognosis group (A1), an intermediate prognosis group (A2, A3, B1 and B2), and a poor prognosis group (B3 and C). The 10-year PCSS rate of three groups were 95.8% vs 85.1% vs 66.5%. Compared to the good prognosis group, the HR of the intermediate and poor prognosis group were 4.21(3.96~4.48) and 11.36 (10.59~12.19). A nomogram was built based on these factors. The C-index of the nomogram was 0.772, indicating a good accuracy of the model. Conclusions: We regrouped men with high-risk PCa according to their prognosis. PCa with three high-risk factors was not more aggressive than that with two of GS 8-10 and PSA >20 ng/ml.