Radical Prostatectomy for High-risk Prostate Cancer Defined by Preoperative Criteria: Oncologic Follow-up in National Multicenter Study in 813 Patients and Assessment of Easy-to-use Prognostic Substratification

Ploussard, Guillaume; Masson-Lecomte, A.; Beauval, Jean-Baptiste; Ouzzane, A.; Bonniol, R.; Buge, François; Fadli, Saad Ed Dine; Rouprêt, Morgan; Rébillard, Xavier; Gaschignard, N.; Pfister, Christian; Villers, Arnauld; Soulié, M.; Salomon, Laurent

doi:10.1016/j.urology.2011.05.021

Cited by 53 publications

(35 citation statements)

References 24 publications

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“…Joniau et al [25] construct a pretreatment table to predict the final histopathology and to help the decision-making process in clinical locally advanced disease. Others elaborated a preoperative stratification tool in high-risk PCa with the aim of identifying the best candidates for RP [7,25,26,27,28]. …”

Section: Discussionmentioning

confidence: 99%

External Validation of Nomogram Predicting the Probability of Specimen-Confined Disease (pT2-3a, R0N0) in Patients Undergoing Radical Prostatectomy and Pelvic Lymph Node Dissection

et al. 2013

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Introduction: Before radical prostatectomy (RP), a nomogram [Briganti et al., Eur Urol 2012;61:584-592] permits to measure the probability of specimen-confined (SC) disease (pT2-pT3a, node negative with negative margins) in high-risk prostate cancer (PCa). The aim of our study was to perform an external validation of this nomogram. Materials and Methods: Between 2007 and 2011, 623 patients with high-risk PCa (prostate-specific antigen (PSA) >20 ng/ml and/or biopsy Gleason score ≥8 and/or clinical stage T3) underwent RP and pelvic lymph node dissection at tertiary referral centers. Multivariable logistic regression models predicting the presence of SC disease were built in; we then used the area under curve of the receiver operating characteristic analysis to quantify accuracy of the nomogram to predict SC disease. The extent of over- or underestimation was evaluated within calibration plots. Results: 29% (181/623) of men had SC disease at RP. Preoperative PSA, biopsy Gleason score and stage differed significantly (all p < 0.001) between men with SC disease and those without. External validation of the nomogram showed an acceptable accuracy (area under curve: 66.3, 95% CI 62.4-70%) and a perfect calibration plot. Conclusions: The external cohort validates the original nomogram, with perfect calibration characteristics. The adequate although reduced accuracy may reflect the wide spectrum and behavior of the so-called high-risk PCa.

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Section: Discussionmentioning

confidence: 99%

External Validation of Nomogram Predicting the Probability of Specimen-Confined Disease (pT2-3a, R0N0) in Patients Undergoing Radical Prostatectomy and Pelvic Lymph Node Dissection

et al. 2013

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“…In fact, men with a high level of PSA and a Gleason grade ≤ 7 had very low risk for cancer progression. Alternatively, men with multiple high-risk features (i.e., PSA > 20ng/mL, biopsy Gleason score 8-10, or clinical stage T3 disease) had poor outcomes despite surgery (15).…”

Section: Discussionmentioning

confidence: 99%

Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Purpose: To evaluate outcomes of patients with high risk prostate cancer (PCa) who underwent radical prostatectomy (RP) in a context of a multidisciplinary approach including adjuvant radiation (RT) + androgen deprivation therapy (ADT). Matherials and Methods: 244 consecutive patients with high risk localized PCa underwent RP and bilateral extended pelvic lymph node dissection at our institution. Adjuvant RT + 24 months ADT was carried out in subjects with pathological stage ≥ T3N0 and/or positive surgical margins or in patients with local relapse. Results: After a median follow-up was 54.17 months (range 5.4-117.16), 13 (5.3%) subjects had biochemical progression, 21 (8.6%) had clinical progression, 7 (2.9%) died due to prostate cancer and 15 (6.1%) died due to other causes. 136 (55.7%) patients did not receive any adjuvant treatment while 108 (44.3%) received respectively adjuvant or salvage RT+ADT. Multivariate Cox proportional hazard analysis showed that pre--operative PSA value at diagnosis is a significant predictive factor for BCR (HR: 1.04, p < 0.05) and that Gleason Score 8-10 (HR: 2.4; p<0.05) and PSMs (HR: 2.01; p < 0.01) were significant predictors for clinical progression. Radical prostatectomy group was associated with BPFS, CPFS, CSS and OS at 5-years of 97%, 90%, 95% and 86% respectively, while adjuvant radiation + androgen deprivation therapy group was associated with a BPFS, CPFS and CSS at 5-years of 91%, 83%, 95% and 88%, without any statistical difference. Conclusions: Multimodality tailored treatment based on RP and adjuvant therapy with RT+ADT achieve similar results in terms of OS after 5-years of follow-up.

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“…La PT par voie rétropubienne est la technique utilisée dans la majorité des séries publiées sur les CPHR, notamment pour les tumeurs de stade T3 [6,13,14,25,30,34,38].…”

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“…Les taux de survie sont proches de ceux obtenus par l'association hormonoradiothé-rapie, qui est le traitement de réfé-rence à ce stade (survie spécifique après PT respectivement de 85 à 99 % à cinq ans, de 72 à 92 % à dix ans et de 76 à 84 % à 15 ans) [4,6,13,25,34].…”

Section: Résultats Carcinologiquesunclassified

Management of high-risk prostate cancer: surgery or radiotherapy with hormonal treatment

Soulié

Richaud

2012

Oncologie

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Among the different treatment options recommended for high-risk prostate cancer (HRPC), radical prostatectomy (RP) is recognized along with radiotherapy, but its role is still controversial in monotherapy and difficult to evaluate in combined treatments. The results of clinical trials combining an external radiotherapy with a long-term androgen deprivation in locally advanced tumours sustain the principle of a multidisciplinary management in HRPC. Clinical and histological data associated with the MRI assessment remain essential and enhance the preoperative multidisciplinary decision, especially regarding nodal and distant metastases. An enlarged RP with an extended pelvic lymphadenectomy can be considered a viable alternative to radiotherapy and hormonal therapy. Morbidity of the procedure is similar to RP for organ-confined tumours, despite more erectile dysfunction due to non-sparing RP is observed in most of the cases. Oncological results of recent studies show 10-year and 15-year specific survival rates to be around 85% and 75% respectively, similar to those with hormonoradiotherapy.

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Radical Prostatectomy for High-risk Prostate Cancer Defined by Preoperative Criteria: Oncologic Follow-up in National Multicenter Study in 813 Patients and Assessment of Easy-to-use Prognostic Substratification

Cited by 53 publications

References 24 publications

External Validation of Nomogram Predicting the Probability of Specimen-Confined Disease (pT2-3a, R0N0) in Patients Undergoing Radical Prostatectomy and Pelvic Lymph Node Dissection

External Validation of Nomogram Predicting the Probability of Specimen-Confined Disease (pT2-3a, R0N0) in Patients Undergoing Radical Prostatectomy and Pelvic Lymph Node Dissection

Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study

Management of high-risk prostate cancer: surgery or radiotherapy with hormonal treatment

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