A wide variety of clincal and pathological criteria have been proposed as data sets to stratify men into “high risk” prostate cancer groups. Nguyen et al. have now published data suggesting that the stratification criteria actually have no effect on survival (at least for six of the more commonly used criteria sets).
The study population included 708 men who underwent radical prostatectomy (RP) from 1987 to 1995 (Group A) and another 3,351 men who had an RP between 1996 and 2007 (Group B). Patients who received adjuvant therapy or had no postoperative PSA data available were excluded from analysis.
High risk patients were identified based on six commonly used definitions. Biochemical failure was defined as a PSA level ≥ 0.4 ng/ml and increasing or initiation of salvage therapy.
The results of the analysis can be sumarrized as follows:
- Regardless of the definition criteria, high risk patients demonstrated a 2.7 to 5.3-fold increased hazard of biochemical relapse, and 5 and 10-year biochemical relapse-free survival rates were 36-58 percent and 25-43 percent, respectively.
- When stratified by date of treatment, patients in Group A generally had worse biochemical relapse-free survival compared to those in Group B.
- Within Groups A and B, there was no significant variation in biochemical relapse-free survival.
The authors conclude that biochemical relapse-free survival after RP does not vary substantially based on the specific definition of high-risk prostate cancer and that there is a trend toward improved biochemical relapse-free survival in patients treated more recently, perhaps reflecting stage migration or changes in surgical technique. They also propose that high-risk prostate cancer may represent a relatively homogeneous population.
Filed under: Management, Treatment Tagged: | "high risk", outcome, prostatectomy
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