Validating the association of adverse pathology with distant metastasis and prostate cancer mortality 20-years after radical prostatectomy

Michael A. Brooks, Lewis Thomas, Cristina Magi-Galluzzi, Jianbo Li, Michael R. Crager, Ruixiao Lu, Frederick L. Baehner, John Abran, Tamer Aboushwareb, Eric A. Klein

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: To assess the association of adverse pathology (AP), defined as high-grade (≥ Gleason Grade Group 3) and/or non-organ confined disease, with long-term oncologic outcomes after radical prostatectomy (RP). Materials and Methods: Using a stratified cohort sampling design, we evaluated the association of AP with the risk of distant metastasis (DM) and prostate cancer-specific mortality (PCSM) up to 20 years after RP in 428 patients treated between 1987 to 2004. Cox regression of cause-specific hazards was used to estimate the absolute risk of both endpoints, with death from other causes treated as a competing risk. Additionally, subgroup analysis in patients with low and/or intermediate-risk disease, who are potentially eligible for active surveillance (AS), was performed. Results: Within the cohort sample, 53% of men exhibited AP at time of RP, with median follow up of 15.5 years (IQR 14.6-16.6 years) thereafter. Adverse pathology was highly associated with DM and PCSM in the overall cohort (HR 12.30, 95% confidence interval [CI] 5.30-28.55, and HR 10.03, 95% CI 3.42-29.47, respectively, both P < 0.001). Adverse pathology was also highly associated with DM and PCSM in the low/intermediate-risk subgroup (HR 10.48, 95% CI 4.18-26.28, and 8.60, 95% CI 2.40-30.48, respectively, both P < 0.001). Conclusions: Adverse pathology at the time of RP is highly associated with future development of DM and PCSM. Accurate prediction of AP may thus be useful for individualizing risk-based surveillance and treatment strategies.

Original languageEnglish
Pages (from-to)104.e1-104.e7
JournalUrologic Oncology: Seminars and Original Investigations
Volume40
Issue number3
DOIs
StatePublished - Mar 2022

Keywords

  • Adverse pathology
  • Gleason Score upgrade
  • long-term outcomes
  • Prostate cancer
  • Radical prostatectomy

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