Determinants of oncologic outcomes in high‐grade organ‐confined prostate cancer after prostatectomy

TL;DR

This study examines outcomes for patients with high-grade prostate cancer confined to the prostate after surgery, identifying factors like tumor size and PSA levels that predict cancer recurrence and spread.

Contribution

The study identifies preoperative PSA and tumor size as independent predictors of outcomes in high-grade prostate cancer confined to the prostate after surgery.

Findings

Preoperative PSA levels are an independent predictor of biochemical recurrence in high-grade prostate cancer patients.

Tumor size (cut-off 15 mm) is an independent predictor of metastasis risk in these patients.

Large cribriform components and lymphovascular invasion are associated with metastasis risk but not independently.

Abstract

In radical prostatectomy (RP), Grade Group (GG) 4/5 prostate cancer [high‐grade prostate cancer (HGPC) hereafter] is often associated with extension beyond the prostate and positive surgical margins. Hence, there is limited information on post‐RP outcomes of patients with completely resected HGPC confined to the prostate (pT2).

Clinical outcomes were assessed in a cohort of patients with pT2 HGPC and negative surgical margins using Kaplan‐Meier statistics and Cox regression analysis.

Four hundred and seven RPs were initially assessed: 236 (58%) with GG 4 and 171 (42%) with GG 5 prostate cancer (PCa). Survival analysis was performed on subsets of patients with available follow‐up (BCR: n = 343, metastases: n = 347) to identify clinicopathologic variables associated with the risk of biochemical recurrence and metastasis. The size of the dominant nodule (cut‐off 15 mm) (HR 1.654, 95% CI 1.026–2.667; P = 0.04) and the preoperative PSA level (HR 1.052, 95% CI 1.009–1.097; P = 0.02) were associated with a higher likelihood of BCR on univariate regression analysis, with only preoperative PSA remaining significant when both variables were assessed concurrently (HR 1.051, 95% CI 1.007–1.098; P = 0.02). On univariate Cox regression analysis, the size of the dominant nodule (cut‐off: 15 mm; HR 6.315, 95% CI 2.021–19.725; P < 0.01), the presence of large cribriform components (HR 4.375, 95% CI 0.999–19.159; P = 0.05), and LVI (HR 3.808, 95% CI 1.086–13.354; P = 0.04) were associated with the risk of metastasis, but only size remained an independent predictor on multivariate analysis (HR 5.66, 95% CI 1.761–18.191; P < 0.01In p for cut‐off of 15 mm).

In patients with pT2 HGPC and negative margins, both the size of the dominant nodule (cut‐off = 15 mm) and the preoperative PSA levels are associated with a higher risk of BCR, with preoperative PSA levels representing an independent predictor. Additionally, cribriform PCa, LVI, and a tumour size seem to portend a higher risk of metastasis, with size remaining an independent predictor when these variables are assessed concurrently.

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