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Prostate Cancer

Pretreatment Tables Predicting Pathologic Stage of Locally Advanced Prostate Cancer

By: Steven Joniau a , Martin Spahn b , Alberto Briganti c , Giorgio Gandaglia c , Bertrand Tombal d , Lorenzo Tosco a , Giansilvio Marchioro e , Chao-Yu Hsu a , Jochen Walz f , Burkhard Kneitz g , Pia Bader h , Detlef Frohneberg h , Alessandro Tizzani i , Markus Graefen f , Paul van Cangh d , R. Jeffrey Karnes j , Francesco Montorsi c , Hein van Poppel a , Paolo Gontero i for the European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT).

European Urology, Volume 67 Issue 2, October 2015, Pages 319-325

Published online: 20 October 2015

Keywords: Locally advanced prostate cancer, Pretreatment tables, Radical prostatectomy, Prostate cancer

Abstract Full Text Full Text PDF (1,9 MB) Patient Summary

Abstract

Background

Pretreatment tables for the prediction of pathologic stage have been published and validated for localized prostate cancer (PCa). No such tables are available for locally advanced (cT3a) PCa.

Objective

To construct tables predicting pathologic outcome after radical prostatectomy (RP) for patients with cT3a PCa with the aim to help guide treatment decisions in clinical practice.

Design, setting, and participants

This was a multicenter retrospective cohort study including 759 consecutive patients with cT3a PCa treated with RP between 1987 and 2010.

Intervention

Retropubic RP and pelvic lymphadenectomy.

Outcome measurements and statistical analysis

Patients were divided into pretreatment prostate-specific antigen (PSA) and biopsy Gleason score (GS) subgroups. These parameters were used to construct tables predicting pathologic outcome and the presence of positive lymph nodes (LNs) after RP for cT3a PCa using ordinal logistic regression.

Results and limitations

In the model predicting pathologic outcome, the main effects of biopsy GS and pretreatment PSA were significant. A higher GS and/or higher PSA level was associated with a more unfavorable pathologic outcome. The validation procedure, using a repeated split-sample method, showed good predictive ability. Regression analysis also showed an increasing probability of positive LNs with increasing PSA levels and/or higher GS. Limitations of the study are the retrospective design and the long study period.

Conclusions

These novel tables predict pathologic stage after RP for patients with cT3a PCa based on pretreatment PSA level and biopsy GS. They can be used to guide decision making in men with locally advanced PCa.

Patient summary

Our study might provide physicians with a useful tool to predict pathologic stage in locally advanced prostate cancer that might help select patients who may need multimodal treatment.

Take Home Message

We constructed novel tables based on pretreatment prostate-specific antigen level and biopsy Gleason score for the prediction of pathologic stage, positive lymph nodes, and positive margins in locally advanced prostate cancer. These may be used for patient counseling by urologists and radiation oncologists.

Keywords: Locally advanced prostate cancer, Pretreatment tables, Radical prostatectomy, Prostate cancer.

Footnotes

a Department of Urology, University Hospitals, Leuven, Belgium

b Department of Urology, University of Bern, Bern, Switzerland

c Department of Urology, San Raffaele Vita e Salute University, Milan, Italy

d Department of Urology, Université Catholique de Louvain, Brussels, Belgium

e Department of Urology, University of Piemonte Orientale, Novara, Italy

f Department of Urology, University Medical Center Eppendorf, Hamburg, Germany

g Department of Urology, Julius Maximilians Universität Würzburg, Würzburg, Germany

h Department of Urology, Community Hospital Karlsruhe, Karlsruhe, Germany

i Department of Urology, University of Turin, Turin, Italy

j Department of Urology, Mayo Clinic, Rochester, MN, USA

Corresponding author. University Hospital Leuven, Department of Urology, Herestraat 49, 3000 Leuven, Belgium. Tel. +32 16 34 69 45; Fax: +32 16 34 69 31.

These authors contributed equally as first authors of the manuscript.

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