Date Published: May 13, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Nobumichi Tanaka, Kiyohide Fujimoto, Akihide Hirayama, Yasushi Nakai, Yoshitomo Chihara, Satoshi Anai, Atsushi Tomioka, Keiji Shimada, Noboru Konishi, Yoshihiko Hirao.
Purpose. The purpose of this study is to investigate whether the clinicopathological biopsy findings can predict the oncological outcome in patients who undergo radical prostatectomy. Materials and Methods. Between January 1997 and March 2006, 255 patients with clinically localized adenocarcinoma of the prostate (clinical T1-3N0M0) who had undergone retropubic radical prostatectomy were enrolled in this study. None of the patients received neoadjuvant or adjuvant therapy. Clinicopathological parameters were assessed to determine a predictive parameter of biochemical recurrence. Results. Of the total 255 patients, 77 showed biochemical recurrence during the follow-up period. The estimated 5-year overall survival, 5-year cause-specific survival, and 5-year biochemical recurrence-free survival rates were 97.7%, 99.5%, and 67.3%, respectively. Multivariate analysis using the Cox proportional hazards model showed that calculated cancer volume was an independent predictor among the preoperative clinicopathological parameters (P < 0.05). SVI and PSM were independent predictors among the postoperative parameters (SVI; P < 0.001, PSM; P = 0.049). Among the significant preoperative and postoperative parameters, calculated cancer volume remained an independent predictive parameter in multivariate analysis (P < 0.01). Conclusions. Tumor volume, as calculated by preoperative parameters, is an independent predictor of biochemical recurrence in patients who had undergone radical prostatectomy.
Radical prostatectomy has been the gold standard of definitive therapy for patients with localized prostate cancer for years . Now, not only laparoscopic radical prostatectomy, but recently also robotic radical prostatectomy has remained popular over the years all across the world [2, 3].
Between January 1997 and March 2006, there were 577 patients who consecutively underwent retropubic radical prostatectomy at Nara Medical University Hospital and its affiliate hospitals. Among all of these patients, 255 patients who did not receive neoadjuvant or adjuvant therapy and had clinically localized adenocarcinoma of the prostate (clinical T1-3N0M0; 2002 UICC classification ) were enrolled in this retrospective study. The mean follow-up period was 53 months (range: 12–127 months). The mean age at surgery and PSA value at diagnosis were 67.4 years and 10.9 ng/mL, respectively.
Of the total 255 patients, 77 showed biochemical recurrence during the follow-up period. Of these 77 patients, 2 patients showed clinical recurrence, and 63 patients underwent salvage therapy (44 patients: androgen deprivation therapy, 11 patients: radiotherapy, and 8 patients: both androgen deprivation therapy and radiotherapy), while 14 patients took a wait-and-see approach after biochemical recurrence. The estimated 5-year overall survival, cause-specific survival and biochemical recurrence-free survival rates were 97.7%, 99.5%, and 67.3%, respectively. The estimated 10-year overall survival, cause-specific survival, and biochemical recurrence-free survival rates were 80.2%, 99.5%, and 56.2%, respectively. Patients’ demographics are listed in Tables 1 and 2. PSA level at diagnosis, biopsy Gleason score, clinical T stage, calculated cancer volume, percent positive biopsy core and risk classification were statistically higher in patients who showed biochemical recurrence than in those who did not show biochemical recurrence.
Many investigators have tried to determine independent predictors of biochemical recurrence in patients who had undergone radical prostatectomy [8–20]. Among the preoperative clinicopathological parameters, PSA at biopsy, biopsy Gleason score, clinical stage, percent biopsy core, risk classification, and calculated tumor volume were reported as independent predictors, while pathological stage, EPE, SVI, PSM, tumor volume, and surgical Gleason score were reported as independent predictors of biochemical recurrence among the postoperative pathological parameters.
The calculated tumor volume by preoperative parameters can be an independent predictor of recurrence for patients and will experience biochemical recurrence.