Kaplan-Meier method. The CSM and ... Kaplan Meier and Cox regression methods .... Germany; Georg Salomon, Hartwig Huland, Markus Graefen, Hamburg,.
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
INTRODUCTION AND OBJECTIVES: Data on the oncologic outcomes of high-risk prostate cancer (HRPCa) patients at 20 years after radical prostatectomy (RP) are lacking. The aim of our investigation was to evaluate the long-term patterns of biochemical (BCR), clinical recurrence (CR), cancer specific mortality (CSM) and othercause mortality (OCM) in a multi-institutional database of surgicallytreated HRPCa patients. METHODS: We evaluated 2280 patients with HRPCa treated with RP and pelvic lymph node dissection at 3 tertiary care centers between 1986 and 2015. High-risk prostate cancer was defined according to D’Amico criteria. We estimated BCR and CR rates using the Kaplan-Meier method. The CSM and OCM rates were obtained using competing risk analyses. BCR, CR, and CSM were assessed after 20 years from surgery. Cox regression analyses assessed predictors of long-term oncological outcomes. RESULTS: Median follow-up was 210 months. Median age was 66 years. The 20-year overall BCR-free survival and CR-free survival rates were 36.7% and 76.3%. Overall, 1050 experienced BCR. The latest BCR was registered at 237 months after RP. Out of 1230 patients who experienced BCR, 394 (37.5%) developed CF, while 656 (62.5%) were CF-free at last follow-up. The latest CF was registered at 244 months from RP. Overall, 394 and 172 patients experienced OCM and CSM. The competing risk 20 years CSM and OCM rates were 12.4 and 30.8%. Overall, 74 patients (3.5%) had a follow up 20 years. Of those, 7 (9.2%) and 1 (1.3%) experienced CSM and OCM. The 25-year competing-risks OCM and CSM-free survival rates were 77.9 and 98.5%. Age at RP (HR¼0.97), pathological Gleason score 6 (HR¼3.73), time to BCR (HR¼1.01) and number of nodes removed (HR¼1.06) were predictors of being free from overall mortality at 20year follow up (all p0.04). Among patients with a follow-up 20 years (n¼74), 39 (51.3%) experienced BCR at a median follow-up of 214 months. No patient developed BCR after 20 years from RP. Moreover, 12 (33.3%) developed CF within 20 years (median follow-up 231 months), while only 1 (1.5%) developed CF after 20 years from RP. CONCLUSIONS: Among HRPCa patients, CSM may still occur even after 20 years from RP. Therefore, long monitoring and follow-up should be prolonged even after this time point. Moreover, time to BCR was a strong predictor of reaching a long follow-up after surgery and should be considered as a main criterion to further stratify patients according to their risk of CF and mortality over time. Source of Funding: none
PD51-09 CONDITIONAL PROBABILITY OF BIOCHEMICAL RECURRENCE-FREE SURVIVAL AND CANCER-SPECIFIC MORTALITY AFTER RADICAL PROSTATECTOMY AT LONG TERM FOLLOW-UP
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surgery at 10 years; p0.001. Negative margins, Gleason6 and no extracapsular extension in the specimen were found to have higher BCR-free survival (all p< 0.001). Conditional probability of BCR after surgery 1st year is 6.7%. Those who reach the 2nd year without recurrence have a relapse probability of 4%, (cumulative probability 9.8%) That probability falls to 3.5% after the 3rd year (cumulative probability 13%), 2% after the 4th year (cumulative probability 15%) and is 2.1% after the 5th year (cumulative probability 17%). After 10 years of follow-up without recurrence, the subsequent probability of relapse is 0.8%, (cumulative probability 21%). A total of 92 (1.48%) patients died of disease. Among patients with BCR, those who recur within the first three years of follow-up had higher CSM (9% vs 4% for BCR after 3 years; p¼0.04). The table shows the variables associated with CSM in multivariable analysis. CONCLUSIONS: We found a 50% decrease in BCR probability in patients who had not recurred with the first 3 years. Similar drop was identified for CSM. This is not only useful for patients counseling but also to optimize postoperative follow-up strategies.
Source of Funding: none
PD51-10 SURVIVAL AFTER RADICAL PROSTATECTOMY IN PATIENTS WITH PSA PERSISTENCE: THE IMPACT OF COMPETING CAUSES OF MORTALITY
Silvia Garcia-Barreras*, Rafael Sanchez-Salas, Igor Nunes-Silva, Paris, France; Fernando Secin, Buenos Aires, Argentina; Victor Srougi, Mohammed Baghdadi, Eric Barret, François Rozet, Marc Galiano, Xavier Cathelineau, Paris, France
Giorgio Gandaglia*, Milan, Italy; William Parker, Rochester, NY; Nicola Fossati, Paolo Dell’Oglio, Armando Stabile, Carlo Andrea Bravi, Luigi Nocera, Francesco Pellegrino, Emanuele Zaffuto, Nazareno Suardi, Francesco Montorsi, Milan, Italy; R. Jeffrey Karnes, Stephen Boorjian, Rochester, NY; Alberto Briganti, Milan, Italy
INTRODUCTION AND OBJECTIVES: To estimate the conditional probability of biochemical recurrence (BCR) free survival and cancer-specific mortality (CSM) for men with clinically localized prostate cancer (PCa) treated with radical prostatectomy (RP). METHODS: The study population consisted of 3576 consecutive patients who underwent laparoscopic radical prostatectomy (LARP) and 2619 men treated with robotic radical prostatectomy (RARP) in the last 15 years at our institution. BCR was defined as PSA0.2 ng/dl. PCa death was defined as patients who died with metastasis in an androgen independent setting. Kaplan Meier and Cox regression methods was used to estimate BCR and CSM conditional probabilities. RESULTS: Median follow-up was 8.49 years (IQR 4.01-12.97). Positive surgical margins (PSM) were identified in 1202 patients (19.4%); of these, 664 (55.24%) had organ confined disease and 523 (43.51%) had extraprostatic extension (EPE). BCR-free survival rate was significantly higher with RARP (83% vs 77% for laparoscopic
INTRODUCTION AND OBJECTIVES: We aimed to assess the risk of cancer-specific mortality (CSM) in patients with PSA persistence after radical prostatectomy (RP) after accounting for other-cause mortality (OCM). We hypothesized that a non-negligible proportion of patients is at risk of dying from other causes and would not benefit from additional cancer therapies. METHODS: We included 829 patients with localized PCa undergoing RP at two referral centers between 1994 and 2014. All patients had PSA persistence after RP defined as a PSA 0.1 ng/ml at 8 weeks after surgery. A graphical illustration of the 10-year CSM and OCM rates was generated using competing-risks Poisson regression analyses. Patients were stratified according to age (6, extracapsular extension (ECE), seminal vesicles invasion (SVI) and nodal invasion (LNI), respectively. In patients submitted to immediate RP, 85 (30.9%), 13 (4.7%), 1 (0.4%) and 0 (0%) had Gleason score >6, ECE,
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
SVI and LNI, respectively. Patients initially managed with AS had higher rates of Gleason >6 (7.7% vs. 35.4%), ECE (22.9 vs. 4.7%), SVI (4.2 vs. 0.4%), LNI (6.3 vs. 0%) and higher (all p
