Impact of preoperative risk on metastatic progression and cancer-specific mortality in patients with adverse pathology at radical prostatectomy

OBJECTIVE: To evaluate the impact of preoperative risk category on metastatic disease and prostate cancer-specific mortality (CSM) in patients with prostate cancer (PCa) with adverse pathology at radical prostatectomy (RP).

PATIENTS AND METHODS: The records of 6 943 patients who underwent RP at a European tertiary centre were analysed. Biochemical recurrence (BCR), metastatic disease and CSM were assessed for patients with adverse pathology at RP, and stratified according to preoperative low- vs intermediate-/high-risk PCa groups. Kaplan-Meier, cumulative incidence, Cox regression and competing risk regression analyses were performed.

RESULTS: In patients with extracapsular extension, the metastatic disease rate was 1.6% vs 8% (P < 0.001) and the CSM rate was 2% vs 5% (P = 0.041) for low vs intermediate-/high-risk patients, respectively, at 10 years. In patients with pathological Gleason score ≥3+4, the metastatic disease rate was 3.0% vs 12% (P < 0.001) and the CSM rate was 3% vs 8%, respectively (P < 0.001). In patients with positive surgical margins (PSMs), the metastatic disease rate was 2.9% vs 15% (P < 0.001) and the CSM rate was 4% vs 10%, respectively (P = 0.0001). Low-risk status was a predictive factor for metastatic disease in patients with pathological Gleason score ≥3+4 (hazard ratio [HR] 0.51), pathological Gleason score ≥4+3 (HR 0.41) and PSMs (HR 0.46) and was a predictive factor for CSM risk in patients with pathological Gleason score ≥3+4 (HR 0.62).

CONCLUSIONS: Patients with low-risk PCa were at significantly lower risk of metastatic disease and CSM than their intermediate-/high-risk counterparts, when adverse pathological features were identified at RP. This should be emphasized in the decision-making process after RP.