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Outcomes After Radical Prostatectomy: Very High–Risk vs. High-Risk Patients

By: Cordi Craig
Posted: Thursday, January 24, 2019

Results from a validation study published in Cancer concluded that men with very high–risk prostate cancer may be more likely to experience adverse pathologic and oncologic outcomes after undergoing radical prostatectomy than men with high-risk disease. Brian F. Chapin, MD, of The University of Texas MD Anderson Cancer Center, and colleagues suggested that “very high–risk” prostate cancer is a clinically relevant risk stratum criterion that may help identify men with worse outcomes after standardized treatments.

“From now on…the collective challenge for physicians treating prostate cancer is to develop improved treatment approaches…that allow men with very high–risk prostate cancer to achieve durable cancer control,” the authors concluded.

Dr. Chapin’s team compared the outcomes of almost 2,000 men who underwent radical prostatectomy for high-risk prostate cancer at 3 tertiary care centers between 2005 and 2015. Men were classified as having very high–risk disease if they had more than 4 biopsy cores with a Gleason grade sum of 8 to 10 or a primary Gleason grade pattern of 5. Men classified as having very high–risk disease were compared with those who had high-risk disease.

Overall, the 602 men with very high–risk prostate cancer had significantly higher positive surgical margins than those classified with high-risk disease (37% vs. 25%; P < .001). Significantly more men in the very high–risk group also had positive lymph nodes (37% vs. 15%; P < .001). In addition, those in the very high–risk group had a significantly higher risk of metastasis (2.8-fold), cancer-specific mortality (6.8-fold), and overall mortality (2.4-fold) compared with men who had high-risk disease.

“These criteria may be useful for counseling individual patients regarding the treatment and prognosis for high-risk disease and the risk of needing subsequent postoperative therapies,” suggested the investigators.

Disclosure: The study authors’ disclosure information may be found at wiley.com.



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