Radical Prostatectomy for Patients with High-Risk, Very-High Risk, or Radiographic Suspicion for Metastatic Prostate Cancer: Perioperative and Early Oncologic Results from the MUSIC Statewide Collaborative.
Urologic oncology(2022)
Abstract
Objective: High-risk (HR) prostate cancer (CaP) patients are at greatest risk for occult metastases and disease progression. Radical pros-tatectomy (RP) provides benefit, but remains of unknown oncologic value compared with other options. We investigated outcomes of RP for HR, very-high-risk (VHR), or metastatic CaP. Methods: Included are 1,635 patients undergoing RP between January 2012 and December 2018 (prior to widespread availability of CaP-specific PET imaging). VHR CaP was defined as having >= 2HR features, > 4cores of biopsy Gleason >= 4+4, or primary Gleason pattern 5. Metastatic CaP was defined by radiographic evidence of N1 and/or M1 CaP and grouped as cN1Many and cN0M1. Pre-treatment, periop-erative, and early oncologic data were compared. Patient/tumor characteristics were compared according to risk groups using Chi-squared and Wilcoxon rank-sum tests. Kaplan-Meier analysis of cancer progression and multivariable analyses were performed. Results: Length of stay > 2days and readmission following RP was 10.8% and 5.5% for patients with HR or higher CaP. Median time to progression was 3.9 months (IQR:1.6-13.9), and 2-year progression-free probability was 67% for HR, 53% for VHR, 51% for cN1Many, and 58% for cN0M1. In multivariable analysis, VHR (hazard ratio:1.70; P < 0.0001) and cN1Many (1.96, P < 0.0001) were highly signifi-cant predictors of progression, while cN0M1 was not (P = 0.54), compared with non-metastatic HR CaP. Limitations include selection biases and imprecision of imaging methodologies. Conclusions: Most patients with HR or higher CaP remain progression-free 2 years after RP, with acceptable perioperative outcomes. Progression-free survival was similar in cN1 and VHR patients, better with non-metastatic HR CaP, and between these for cN0M1 patients indicating the imprecise clinical staging occurring with conventional imaging modalities alone. (c) 2022 Elsevier Inc. All rights reserved.
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Key words
Biochemical recurrence free survival,High-risk,Metastatic prostate cancer,Prostate cancer,Prostatectomy
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