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Predictors of prostate-specific antigen progression among men with seminal vesicle invasion at the time of radical prostatectomy.
Cancer. 2004 Apr 15; 100(8):1633-8.C

Abstract

BACKGROUND

Seminal vesicle (SV) invasion at the time of radical prostatectomy (RP) generally is considered to be indicative of poor outcome. The authors examined whether there was a subset of men with SV invasion who had long-term prostate-specific antigen (PSA) progression-free survival.

METHODS

Data were examined from 1687 men who underwent RP between 1988 and 2002 at 5 equal-access medical centers. Patients were grouped based on the presence or absence of SV invasion at the time of RP. Clinical and pathologic variables as well as biochemical outcome data were compared across the groups using rank-sum, chi-square, and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of time to PSA failure among men with SV invasion.

RESULTS

Men with SV invasion had significantly higher PSA values, higher clinical stage, higher grade tumors, and were more likely to have concomitant extracapsular extension or a positive surgical margin. The 5-year PSA progression-free rates for men who had SV invasion was 36%, compared with 70% among men who had no SV invasion. Among men who had SV invasion, using multivariate analysis, only age (P = 0.023), pathologic Gleason score (P = 0.041), and surgical margin status (P = 0.019) were found to be independent predictors of PSA failure. By combining significant prognostic variables, the authors identified a subset of men with SV invasion, low-grade tumors (Gleason score 2-6), and negative surgical margins who had a 5-year PSA progression-free rate of 69%. Men with SV invasion, Gleason scores 2-6 tumors, negative surgical margins, and age > or = 60 years (n = 11; 8%) had a 5-year PSA progression-free rate of 100%.

CONCLUSIONS

Although the majority of men with SV invasion have high-grade disease and a short time to biochemical failure, the authors identified a subset of men with low-grade disease, negative surgical margins, and older age who, despite SV invasion, had an extremely favorable clinical course. Thus, SV invasion does not uniformly suggest an unfavorable prognosis. prognosis.

Authors+Show Affiliations

Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA. sfreedl1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

15073850

Citation

Freedland, Stephen J., et al. "Predictors of Prostate-specific Antigen Progression Among Men With Seminal Vesicle Invasion at the Time of Radical Prostatectomy." Cancer, vol. 100, no. 8, 2004, pp. 1633-8.
Freedland SJ, Aronson WJ, Presti JC, et al. Predictors of prostate-specific antigen progression among men with seminal vesicle invasion at the time of radical prostatectomy. Cancer. 2004;100(8):1633-8.
Freedland, S. J., Aronson, W. J., Presti, J. C., Amling, C. L., Terris, M. K., Trock, B., & Kane, C. J. (2004). Predictors of prostate-specific antigen progression among men with seminal vesicle invasion at the time of radical prostatectomy. Cancer, 100(8), 1633-8.
Freedland SJ, et al. Predictors of Prostate-specific Antigen Progression Among Men With Seminal Vesicle Invasion at the Time of Radical Prostatectomy. Cancer. 2004 Apr 15;100(8):1633-8. PubMed PMID: 15073850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of prostate-specific antigen progression among men with seminal vesicle invasion at the time of radical prostatectomy. AU - Freedland,Stephen J, AU - Aronson,William J, AU - Presti,Joseph C,Jr AU - Amling,Christopher L, AU - Terris,Martha K, AU - Trock,Bruce, AU - Kane,Christopher J, PY - 2004/4/10/pubmed PY - 2004/5/5/medline PY - 2004/4/10/entrez SP - 1633 EP - 8 JF - Cancer JO - Cancer VL - 100 IS - 8 N2 - BACKGROUND: Seminal vesicle (SV) invasion at the time of radical prostatectomy (RP) generally is considered to be indicative of poor outcome. The authors examined whether there was a subset of men with SV invasion who had long-term prostate-specific antigen (PSA) progression-free survival. METHODS: Data were examined from 1687 men who underwent RP between 1988 and 2002 at 5 equal-access medical centers. Patients were grouped based on the presence or absence of SV invasion at the time of RP. Clinical and pathologic variables as well as biochemical outcome data were compared across the groups using rank-sum, chi-square, and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of time to PSA failure among men with SV invasion. RESULTS: Men with SV invasion had significantly higher PSA values, higher clinical stage, higher grade tumors, and were more likely to have concomitant extracapsular extension or a positive surgical margin. The 5-year PSA progression-free rates for men who had SV invasion was 36%, compared with 70% among men who had no SV invasion. Among men who had SV invasion, using multivariate analysis, only age (P = 0.023), pathologic Gleason score (P = 0.041), and surgical margin status (P = 0.019) were found to be independent predictors of PSA failure. By combining significant prognostic variables, the authors identified a subset of men with SV invasion, low-grade tumors (Gleason score 2-6), and negative surgical margins who had a 5-year PSA progression-free rate of 69%. Men with SV invasion, Gleason scores 2-6 tumors, negative surgical margins, and age > or = 60 years (n = 11; 8%) had a 5-year PSA progression-free rate of 100%. CONCLUSIONS: Although the majority of men with SV invasion have high-grade disease and a short time to biochemical failure, the authors identified a subset of men with low-grade disease, negative surgical margins, and older age who, despite SV invasion, had an extremely favorable clinical course. Thus, SV invasion does not uniformly suggest an unfavorable prognosis. prognosis. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/15073850/Predictors_of_prostate_specific_antigen_progression_among_men_with_seminal_vesicle_invasion_at_the_time_of_radical_prostatectomy_ L2 - https://doi.org/10.1002/cncr.20122 DB - PRIME DP - Unbound Medicine ER -