Determinants of oncologic outcomes in high-grade organ-confined prostate cancer after prostatectomy

Abstract

Aims: In radical prostatectomy (RP), Grade Group (GG) 4/5 prostate cancer [high-grade prostate cancer (HGPC) hereafter] is often associated with extension beyond the prostate and positive surgical margins. Hence, there is limited information on post-RP outcomes of patients with completely resected HGPC confined to the prostate (pT2). Materials and methods: Clinical outcomes were assessed in a cohort of patients with pT2 HGPC and negative surgical margins using Kaplan-Meier statistics and Cox regression analysis. Results and conclusion: Four hundred and seven RPs were initially assessed: 236 (58%) with GG 4 and 171 (42%) with GG 5 prostate cancer (PCa). Survival analysis was performed on subsets of patients with available follow-up (BCR: n = 343, metastases: n = 347) to identify clinicopathologic variables associated with the risk of biochemical recurrence and metastasis. The size of the dominant nodule (cut-off 15 mm) (HR 1.654, 95% CI 1.026-2.667; P = 0.04) and the preoperative PSA level (HR 1.052, 95% CI 1.009-1.097; P = 0.02) were associated with a higher likelihood of BCR on univariate regression analysis, with only preoperative PSA remaining significant when both variables were assessed concurrently (HR 1.051, 95% CI 1.007-1.098; P = 0.02). On univariate Cox regression analysis, the size of the dominant nodule (cut-off: 15 mm; HR 6.315, 95% CI 2.021-19.725; P < 0.01), the presence of large cribriform components (HR 4.375, 95% CI 0.999-19.159; P = 0.05), and LVI (HR 3.808, 95% CI 1.086-13.354; P = 0.04) were associated with the risk of metastasis, but only size remained an independent predictor on multivariate analysis (HR 5.66, 95% CI 1.761-18.191; P < 0.01In p for cut-off of 15 mm).