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Percent of cores positive for cancer is a better preoperative predictor of cancer recurrence after radical prostatectomy than prostate specific antigen.
J Urol. 2004 Apr; 171(4):1492-9.JU

Abstract

PURPOSE

We examined the prognostic significance of clinical and pathological variables on outcome following radical retropubic prostatectomy (RRP) in a cohort of patients in the post-prostate specific antigen (PSA) era.

MATERIALS AND METHODS

We reviewed the clinical and pathological data on a cohort of 476 patients who underwent RRP for localized prostate cancer between January 1990 and July 2001 by 1 urologist (WCD). Median age, preoperative PSA and followup were 61 years, 5.8 ng/ml and 49 months, respectively. We used Cox proportional hazard modeling to evaluate the prognostic significance of clinical and pathological variables for cancer recurrence, defined as 2 successive PSA determinations 0.3 ng/ml or greater.

RESULTS

Of the 476 patients 53 (11%) had recurrence. Estimated cancer nonprogression probability was 86% (95% CI 83 to 90) and 76% (95% CI 68 to 86) at 5 and 10 years, respectively. Two multivariate analyses were performed. The first analysis, using only preoperative indicators, found that the percent of biopsy cores positive for cancer and biopsy Gleason score were the best predictive indicators of recurrence. The second multivariate analysis, using preoperative and postoperative indicators, found that the percent of biopsy cores positive for cancer, RRP Gleason score and the combined pathological stage/margin status variable were the best predictive indicators of recurrence. PSA was not found to be an important predictor of recurrence on either multivariate analysis. Patients with a percent of biopsy cores in the upper half of the distribution (greater than 28% positive) were at significantly increased risk for recurrence compared with those in the lower half of the distribution (28% or less positive) (HR 3.86, p <0.001).

CONCLUSIONS

The percent of cores positive for cancer was a better predictor of cancer recurrence than PSA in this post-PSA era RRP series. In addition, surgical Gleason score and pathological stage/surgical margins were also independent predictors of cancer recurrence after RRP. These 3 predictors are displayed in a nomogram-type format to summarize estimated 5 and 10-year recurrence-free probabilities.

Authors+Show Affiliations

Division of Urologic Surgery and Biometrics Center (MMR), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15017206

Citation

San Francisco, Ignacio F., et al. "Percent of Cores Positive for Cancer Is a Better Preoperative Predictor of Cancer Recurrence After Radical Prostatectomy Than Prostate Specific Antigen." The Journal of Urology, vol. 171, no. 4, 2004, pp. 1492-9.
San Francisco IF, Regan MM, Olumi AF, et al. Percent of cores positive for cancer is a better preoperative predictor of cancer recurrence after radical prostatectomy than prostate specific antigen. J Urol. 2004;171(4):1492-9.
San Francisco, I. F., Regan, M. M., Olumi, A. F., & DeWolf, W. C. (2004). Percent of cores positive for cancer is a better preoperative predictor of cancer recurrence after radical prostatectomy than prostate specific antigen. The Journal of Urology, 171(4), 1492-9.
San Francisco IF, et al. Percent of Cores Positive for Cancer Is a Better Preoperative Predictor of Cancer Recurrence After Radical Prostatectomy Than Prostate Specific Antigen. J Urol. 2004;171(4):1492-9. PubMed PMID: 15017206.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percent of cores positive for cancer is a better preoperative predictor of cancer recurrence after radical prostatectomy than prostate specific antigen. AU - San Francisco,Ignacio F, AU - Regan,Meredith M, AU - Olumi,Aria F, AU - DeWolf,William C, PY - 2004/3/17/pubmed PY - 2004/5/7/medline PY - 2004/3/17/entrez SP - 1492 EP - 9 JF - The Journal of urology JO - J Urol VL - 171 IS - 4 N2 - PURPOSE: We examined the prognostic significance of clinical and pathological variables on outcome following radical retropubic prostatectomy (RRP) in a cohort of patients in the post-prostate specific antigen (PSA) era. MATERIALS AND METHODS: We reviewed the clinical and pathological data on a cohort of 476 patients who underwent RRP for localized prostate cancer between January 1990 and July 2001 by 1 urologist (WCD). Median age, preoperative PSA and followup were 61 years, 5.8 ng/ml and 49 months, respectively. We used Cox proportional hazard modeling to evaluate the prognostic significance of clinical and pathological variables for cancer recurrence, defined as 2 successive PSA determinations 0.3 ng/ml or greater. RESULTS: Of the 476 patients 53 (11%) had recurrence. Estimated cancer nonprogression probability was 86% (95% CI 83 to 90) and 76% (95% CI 68 to 86) at 5 and 10 years, respectively. Two multivariate analyses were performed. The first analysis, using only preoperative indicators, found that the percent of biopsy cores positive for cancer and biopsy Gleason score were the best predictive indicators of recurrence. The second multivariate analysis, using preoperative and postoperative indicators, found that the percent of biopsy cores positive for cancer, RRP Gleason score and the combined pathological stage/margin status variable were the best predictive indicators of recurrence. PSA was not found to be an important predictor of recurrence on either multivariate analysis. Patients with a percent of biopsy cores in the upper half of the distribution (greater than 28% positive) were at significantly increased risk for recurrence compared with those in the lower half of the distribution (28% or less positive) (HR 3.86, p <0.001). CONCLUSIONS: The percent of cores positive for cancer was a better predictor of cancer recurrence than PSA in this post-PSA era RRP series. In addition, surgical Gleason score and pathological stage/surgical margins were also independent predictors of cancer recurrence after RRP. These 3 predictors are displayed in a nomogram-type format to summarize estimated 5 and 10-year recurrence-free probabilities. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/15017206/Percent_of_cores_positive_for_cancer_is_a_better_preoperative_predictor_of_cancer_recurrence_after_radical_prostatectomy_than_prostate_specific_antigen_ L2 - https://www.jurology.com/doi/10.1097/01.ju.0000118690.05943.c0?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -