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European Urology

Volume 58, issue 6, pages e53-e62, December 2010

Prostate Cancer

Biochemical Recurrence Following Robot-Assisted Radical Prostatectomy: Analysis of 1384 Patients with a Median 5-year Follow-up eulogo1

Mani Menon, Mahendra Bhandari, Nilesh Gupta, Zhaoli Lane, James O. Peabody, Craig G. Rogers, Jesse Sammon, Sameer A. Siddiqui and Mireya Diaz

Accepted 6 September 2010, Published online 15 September 2010, pages 838 - 846

Abstract Full Text Full-Text PDF (367 KB) Create Platinum Slide Series

Fig. 1 Kaplan-Meier–estimated probability of biochemical recurrence–free survival. The number at risk is given above the x-axis. The 95% confidence interval is represented by the shaded area.BCRFS = biochemical recurrence–free survival.

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References in context

  • Because only 16 patients were followed at 8 yr, much of the analysis is restricted to 7 yr of follow-up (Fig. 1).
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Fig. 2 Biochemical recurrence–free survival by preoperative D’Amico risk groups. The number at risk per D’Amico risk group is given above the x-axis. The pooled p value ascertained by the log-rank test is <0.0001 for all curves.BCRFS = biochemical recurrence–free survival.

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References in context

  • Fig. 2 demonstrates the actuarial BCRFS rate following RARP, stratified by D’Amico risk group.
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Fig. 3 Biochemical recurrence–free survival stratified by Gleason grade for (a) organ-confined disease and (b) non–organ-confined disease. The number at risk per Gleason grade is given above the x-axis. The pooled p value ascertained by the log-rank test is <0.0001 for all curves.BCRFS = biochemical recurrence–free survival.

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References in context

  • Fig. 3 shows BCRFS stratified by Gleason score in patients with organ-confined (Fig. 3a) or non–organ-confined (Fig. 3b) disease.
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  • Fig. 3 shows BCRFS stratified by Gleason score in patients with organ-confined (Fig. 3a) or non–organ-confined (Fig. 3b) disease.
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  • Fig. 3 shows BCRFS stratified by Gleason score in patients with organ-confined (Fig. 3a) or non–organ-confined (Fig. 3b) disease.
    Go to context

Table 1 Clinical and pathologic features of cohort (n = 1384)

Characteristics
Continuous Mean (SD)
Patient age, yr 60.0 (±7.1)
BMI 27.5 (±3.6)
Prostate weight, g 48.3 (±20.1)
Percent tumor volume, % 17.5 (±13.4)

Median (IQR)
Preoperative PSA, ng/ml 5.2 (4.2–7.1)
Follow-up, mo 60.2 (37.2–69.7)
Category n %
Clinical stage:
 T1a–c 1017 73.5
 T2a 208 15.0
 T2b 56 4.0
 T2c 71 5.1
 T3a 27 2.0
 T3b 5 0.4

Biopsy Gleason score:
 5 or 6 844 61.0
 3 + 4 347 25.1
 4 + 3 103 7.5
 8–10 89 6.4
Missing 1 –

Perineural invasion (biopsy):
 Absent 1236 89.4
 Present 146 10.6
 Missing 2 –

Nerve sparing*:
 Partial 716 51.7
 Prostatic fascia sparing** 597 43.2
 Wide excision 71 5.1

Pathologic Gleason score:
 6 541 39.1
 3 + 4 563 40.7
 4 + 3 165 11.9
 8–10 115 8.3

Pathologic stage:
 T2a 196 14.1
 T2b 23 1.7
 T2c 813 58.7
 T3a 293 21.2
 T3b–T4 59 4.3

Margins†:
 Negative 1036 74.9
 Positive 348 25.1

Perineural invasion††
 Absent 552 39.9
 Present 832 60.1

Angiolymphatic invasion††:
 Absent 1347 97.3
 Present 37 2.7

Procedure year
 2001 47 3.4
 2002 254 18.4
 2003 303 21.9
 2004 528 38.2
 2005 252 18.2

SD = standard deviation; BMI = body mass index; IQR = interquartile range.

* Partial nerve sparing: preservation of the dominant neurovascular distribution on the posterolateral prostate. Prostatic fascia sparing: alternatively described as veil of Aphrodite, intrafascial, and high anterior release.

** Unilateral or bilateral.

† Organ confined: 135 of 1032 (13.1%); non–organ confined: 213 of 352 (60.5%).

†† On final pathology.

References in context

  • Clinical and pathologic variables for the study cohort (1384 patients) are depicted in Table 1.
    Go to context

Table 2 Univariable and multivariable Cox proportional hazards regression models of biochemical recurrence incorporating preoperative and biopsy information

Covariate Univariable analysis Multivariable analysis
HR (95% CI) p value Model 1* Model 2*
HR (95% CI) p value HR (95% CI) p value
Age, yr:
 <60** 1 – 1 – 1 –
 ≥60 1.39 (1.04–1.87) 0.0007 0.98 (0.72–1.32) 0.8792 1.20 (0.89–1.61) 0.2358

BMI:
 <25 kg/m2** 1 – 1 – 1 –
 25–30 kg/m2 1.28 (0.83–1.96) 0.2654 1.07 (0.72–1.60) 0.7257 1.15 (0.78–1.71) 0.4846
 ≥30 kg/m2 1.14 (0.77–1.69) 0.5075 1.14 (0.74–1.76) 0.5600 1.21 (0.78–1.86) 0.3910

Preoperative PSA:
 ≤10 ng/ml** 1 – 1 – – –
 10.1–20.0 ng/ml 2.98 (2.03–4.38) <0.0001 2.61 (1.76–3.86) <0.0001 – –
 >20 ng/ml 9.17 (5.28–15.93) <0.0001 6.16 (3.45–11.01) <0.0001 – –

Biopsy Gleason grade:
 5 or 6** 1 – 1 – – –
 3 + 4 3.39 (2.36–4.87) <0.0001 3.05 (2.11–4.43) <0.0001 – –
 4 + 3 6.99 (4.55–10.73) <0.0001 6.17 (3.96–9.62) <0.0001 – –
 8–10 6.22 (3.95–9.80) <0.0001 4.84 (3.00–7.80) <0.0001 – –

Clinical stage:
 T1c/T2a** 1 – 1 – – –
 ≥T2b 1.65 (1.12–2.45) 0.0118 1.42 (0.94–2.16) 0.1004 – –

D’Amico risk group*:
 Low** 1 – – – 1 –
 Intermediate 4.28 (2.92–6.28) <0.0001 – – 4.07 (2.77–5.98) <0.0001
 High 6.16 (4.02–9.45) <0.0001 – – 5.65 (3.62–8.83) <0.0001

Perineural invasion†:
 Negative** 1 – 1 – 1 –
 Positive 2.30 (1.60–3.32) <0.0001 1.39 (0.94–2.07) 0.1016 1.59 (1.09–2.32) 0.0168

Procedure year††:
 2001** 1 – 1 – 1 –
 >2001 0.93 (0.82–1.07) 0.3195 0.88 (0.77–1.00) 0.0569 0.88 (0.77–1.00) 0.0546

HR = hazard ratio; CI = confidence interval; BMI = body mass index; PSA = prostate-specific antigen.

* Multivariable model 2 was generated using the D’Amico risk group as a predictor, supplanting grade, stage, and PSA.

** Reference group.

† On biopsy.

†† Incorporated as a continuous value.

References in context

  • Among preoperative variables (Table 2), PSA ≥20 ng/ml (hazard ratio [HR]: 6.16; 95% CI, 3.45–11.01; p < 0.0001) and Biopsy Gleason 4+3 (HR: 6.17; 95% CI, 3.96–9.62; p<0.0001) were the strongest predictors of BCR.
    Go to context

  • Among preoperative variables (Table 2), PSA ≥20 ng/ml (hazard ratio [HR]: 6.16; 95% CI, 3.45–11.01; p < 0.0001) and Biopsy Gleason 4+3 (HR: 6.17; 95% CI, 3.96–9.62; p<0.0001) were the strongest predictors of BCR.
    Go to context

Table 3 Univariable and multivariable Cox proportional hazards regression models of biochemical recurrence incorporating variables from final pathology

Covariate Univariable analysis Multivariable analysis
HR (95% CI) p value HR (95% CI) p value
Age, yr:
 <60* 1 – 1 –
 ≥60 1.44 (1.07–1.92) 0.0148 1.15 (0.85–1.55) 0.3675

Preoperative PSA:
 ≤10.0 ng/ml* 1 – 1 –
 10.1–20.0 ng/ml 2.98 (2.03–4.38) <0.0001 1.64 (1.10–2.45) 0.0156
 >20 ng/ml 9.17 (5.28–15.93) <0.0001 1.95 (1.06–3.58) 0.0318

Tumor volume:
 <15%* 1 – 1 –
 ≥15% 3.07 (2.16–4.35) <0.0001 1.13 (0.77–1.66) 0.5356

Pathology Gleason grade:
 6* 1 – 1 –
 3 + 4 3.35 (2.06–5.46) <0.0001 1.90 (1.13–3.19) 0.0158
 4 + 3 7.01 (4.13–11.88) <0.0001 3.05 (1.71–5.46) 0.0002
 8–10 16.90 (10.24–27.88) <0.0001 5.37 (2.99–9.65) <0.0001

Stage:
 T2* 1 – 1 –
 EPE 4.60 (3.36–6.30) <0.0001 1.78 (1.21–2.62) 0.0036
 SVI/T4 11.18 (7.38–16.94) <0.0001 2.71 (1.67–4.40) <0.0001

Margins:
 Negative* 1 – 1 –
 Positive 4.87 (3.65–6.51) <0.0001 2.43 (1.72–3.42) <0.0001

Perineural invasion**:
 Negative* 1 – 1 –
 Positive 2.97 (2.07–4.26) <0.0001 1.33 (0.89–1.99) 0.1584

Angiolymphatic invasion*:
 Negative* 1 – 1 –
 Positive 5.54 (3.44–8.91) <0.0001 2.15 (1.30–3.57) 0.0030

Nerve sparing†:
 Partial* 1 – – –
 Prostatic fascia sparing††: 0.46 (0.32–0.64) <0.0001 0.70 (0.48–1.02) 0.0633
 Wide excision 1.64 (1.01–2.67) 0.0437 1.01 (0.62–1.65) 0.9653

Procedure year‡:
 2001* 1 – 1 –
 >2001 0.93 (0.82–1.07) 0.3173 0.94 (0.82–1.08) 0.4035

HR = hazard ratio; CI = confidence interval; PSA = prostate-specific antigen; EPE = extraprostatic extension; SVI = seminal vesical invasion.

* Reference group.

** On final specimen.

† Partial nerve sparing: preservation of the dominant neurovascular distribution on the posterolateral prostate; prostatic fascia sparing: alternatively described as veil of Aphrodite, intrafascial, and high anterior release.

†† Unilateral or bilateral.

‡ Incorporated as a continuous value.

References in context

  • When considering pathologic variables available postoperatively (Table 3), pathologic Gleason grade was the strongest predictor of BCR, with an HR of 1.90 (95% CI, 1.13–3.19; p=0.0158) for Gleason 3+4, 3.05 (95% CI, 1.71–5.46; p=0.0002) for Gleason 4+3, and 5.37 (95% CI, 2.99–9.65; p<0.0001) for Gleason 8–10 when compared to Gleason 6.
    Go to context

  • When considering pathologic variables available postoperatively (Table 3), pathologic Gleason grade was the strongest predictor of BCR, with an HR of 1.90 (95% CI, 1.13–3.19; p=0.0158) for Gleason 3+4, 3.05 (95% CI, 1.71–5.46; p=0.0002) for Gleason 4+3, and 5.37 (95% CI, 2.99–9.65; p<0.0001) for Gleason 8–10 when compared to Gleason 6.
    Go to context

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