High risk prognostic factors after radical prostatectomy

Stefanos Adamis, Ioannis Varkarakis

Abstract


Prostate cancer encompasses a wide spectrum of tumor phenotypes with differing prognoses and tumour recurrence is observed in a significant number of these cases. As treatment should be tailored to each individual patient depending on the features of their disease, urologists need to be able to estimate treatment outcomes. This paper presents the parameters that determine the risk of recurrence after radical prostatectomy. These parameters are based on clinical and histopathological findings, as well as on abnormal changes in PSA values after surgery. Taking these parameters into account, urologists can determine the further appropriate treatment of patients.

 

Ο καρκίνος του προστάτη εμφανίζει ένα ευρύ φάσμα καρκινικών φαινοτύπων με διαφορετικές προγνώσεις και σε σημαντικό αριθμό περιπτώσεων παρατηρείται υποτροπή της νόσου. Καθώς η θεραπευτική αντιμετώπιση της νόσου θα πρέπει να εξατομικεύεται για κάθε ασθενή, ανάλογα με τα χαρακτηριστικά της νόσου, ο ουρολόγος θα πρέπει να είναι σε θέση να προσδιορίζει τα αποτελέσματα της θεραπείας. Στην παρούσα εργασία παρουσιάζονται οι παράμετροι που καθορίζουν τον κίνδυνο υποτροπής μετά από ριζική προστατεκτομή. Οι παράμετροι αυτές βασίζονται σε κλινικά και ιστοπαθολογικά ευρήματα, καθώς και σε παθολογικές μεταβολές των τιμών του PSA μετά το χειρουργείο. Λαμβάνοντας υπόψη τις παραμέτρους αυτές ο ουρολόγος μπορεί να καθορίσει την περαιτέρω ενδεδειγμένη θεραπευτική αντιμετώπιση των ασθενών.


Keywords


prostate cancer; radical prostatectomy; histopathological findings; recurrence risk; του προστάτη, ριζική προστατεκτομή, ιστοπαθολογικά ευρήματα, κίνδυνος υποτροπής

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References


Jemal A, Siegel R, Xu J, Ward E : Cancer statistics. 2010. CA Cancer J Clin 2010; 60: 277 - 300.

Quinn M, Babb P: Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I international comparisons. BJU Int 2002; 90: 162 - 73.

Boyle P, Ferlay J.: Cancer incidence and mortality in Europe 2004. Ann Oncol 2005;16(3): 481 - 8.

Mettlin C, Murphy GP, Babaian RJ, Chesley A, Kane RA, Littrup PJ, et al.: Observation on the early detection of prostate cancer from the American Cancer Society - National Prostate Cancer Detection Project. Cancer 1997; 80: 1814 - 17.

Farkas A, Schneider D, Perrotti M, Cummings CB, Wars WS: National trends in the epidemiology of prostate cancer, 1973 to 1984: evidence for the effectiveness of prostate specific antigen screening. Urology 1986; 52: 444 - 9.

Cooperberg MR, Lubeck DP, Mehla SS, Carroll PR : Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE). J Urol 2009; 170: S21 - S25.

Khan MA, Partin AW: Management of High - risk populations with locally advanced prostate cancer. The Oncologist 2003; 8: 259 - 69.

Babaian RJ, Troncoso P, Bhadkamkar VA, Johnston DA: Analysis of clinicopathologic factors predicting outcome after radical prostatectomy. Cancer 2001; 81: 1414 - 22.

Nguyen CT, Reuther AM, Stephenson AJ, Klein EA, Jones JS: The specific definition of high risk prostate cancer has minimal impact on biochemical relapse - free survival. J Urol 2009; 181:75 - 80.

Loeb S, Schaeffer EM, Trock BJ, Epstein JL, Humphreys EB, Walsh PC: What are the outcomes of radical prostatectomy for high - risk prostate cancer? Urology 2010; 76(3): 710 - 4.

Ward JF, Zincke H, Bergstrahl EJ, Slezak JM, Myers RP, Blute ML: The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy. J Urol 2004; 172: 1328 - 32.

Stephenson AJ, Scardino PT, Eastham JA, Bianco Jr FJ, Dotan ZA, DiBlasio CJ, et al.: Postoperative nomogram predicting the 10 - year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 2005; 23: 7005 - 12.

Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC: Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281: 1591 - 7.

Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC et al.: Risk of prostate cancer - specific mortality following biochemical recurrence after radical prostatectomy. JAMA 2005; 294: 433 - 9.

Gleason DF, Mellinger GT: Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol 2002; 167: 953 - 8.

Delahunt B, Srigley JR, Lamb DS. Gleason grading: consensus and controversy. Pathology 2009; 41: 613 - 4.

Pan CC, Potter SR, Partin AW, Epstein JI. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol 2000; 24: 563 - 9.

Harnden P, Shelley MD, Coles B, Staffurth J, Mason MD. Should the Gleason grading system for prostate cancer be modified to account for high - grade tertiary components? A systematic review and meta - analysis. Lancet Oncol 2007; 8: 411 - 9.

Sim HG, Telesca D, Culp SH, Ellis WJ, Lange PH, True LD et al.: Tertiary Gleason pattern 5 in Gleason7 prostate cancer predicts pathological stage and biochemical recurrence.J Urol 2008; 179: 1775 - 9.

Alenda O, Ploussard G, Mouracade P, Xylinas E, de la Taille A, Allory Y, et al.: Impact of the primary Gleason pattern on biochemical recurrence - free survival after radical prostatectomy: a single - center cohort of 1,248 patients with Gleason 7 tumors. World J Urol 2010.

Epstein JI, Amin M, Boccon - Gibod L, Egevad L, Humphrey PA, Mikuz G, et al.: Prognostic factors and reporting of prostate carcinoma in radical prostatectomy and pelvic lymphadenectomy specimens. Scand J Urol Nephrol Suppl 2005; 216:34 - 63.

Swindle P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N et al.: Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 2005; 174: 903 - 7.

Eastham JA, Kuroiwa K, Ohori M, Serio AM, Gorbonos A, Maru N, et al.: Prognostic significance of location of positive surgical margins in radical prostatectomy specimens. Urology 2007; 70: 965 - 9.

Pfitzenmaier J, Pahernik S, Tremmel T, Haferkamp A, Buse S, Hohenfellner M: Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression? BJU Int 2008; 102: 1413 - 8.

Vis AN, Schroeder FH, van der Kwast TH: The actual value of the surgical margin status as a predictor of disease progression in men with early prostate cancer. Eur Urol 2006; 50: 258 - 65.

Simon MA, Kim S, Soloway MS: Prostate specific antigen recurrence rates are low after radical retropubic prostatectomy and positive margins. J Urol 2006; 175: 140 - 4.

Yossepowitch O, Bjartell A, Eastham JA, Graefen M, Guillonneau BD, Karakiewicz PI, et al.: Positive surgical margins in radical prostatectomy: outlining the problem and its long - term consequences. Eur Urol 2009; 55: 87 - 99.

Eastham JA, Kattan MW, Riedel E, Begg CB, Wheeler T, Geriqk C, et al.: Variation among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol 2003; 170: 2292 - 6.

a. Psutka SP, Feldman AS, Rodin D, Olumi AF, Wu CH, McDougal WS: Men with organ - confined prostate cancer and positive surgical margins develop biochemical failure at a similar rate to men with extracapsular extension. Urology 2011; 78(1): 121 - 5.

b. Cheng L, Darson MF, Bergstrahl EJ, Slezak J, Myers RP, Bostwick DG: Correlation of margin status and extraprostatic extension with progression of prostate carcinoma. Cancer 1999; 86: 1775 - 82.

Alkhateeb S, Alibhai S, Fleshner N, Finelli A, Jewett M, Zlotta A, et al.: Impact of positive surgical margins after radical prostatectomy differs by disease risk group. J Urol 2010; 183: 145 - 50.

Sofer M, Hamilton - Nelson KL, Civantos F, Soloway MS: Positive surgical margins after radical retropubic prostatectomy: the influence of site and number on progression. J Urol 2002; 167: 2453 - 6.

Marks RA, Koch MO, Lopez - Beltran A, Montironi R, Juliar BE, Cheng L: The relationship between the extend of surgical margin positivity and prostate specific antigen recurrence in radical prostatectomy specimens. Hum Pathol 2007; 38: 1207 - 11.

Pettus JA, Weight CJ, Thompson CJ, Middleton RG, Stephenson RA: Biochemical failure in men following radical retropubic prostatectomy: impact of surgical margin status and location. J Urol 2004; 172: 129 - 32.

Aydin H, Tsuzuki T, Hernandez D, Walsh PC, Parin AW, Epstein JI: Positive proximal (bladder neck) margin at radical prostatectomy confers greater risk of biochemical progression. Urology 2004; 64: 551 - 5.

Sakr WA, Wheeler TM, Blute M, Bodo M, Calle - Rodrigue R, Henson DE, et al. Staging and reporting of prostate cancer - sampling of the radical prostatectomy specimen. Cancer 1996; 78: 366 - 8.

Ayala AG, Ro JY, Babaian R, Troncoso P, Grignon DJ: The prostatic capsule: does it exist? Its importance in the staging and treatment of prostatic carcinoma. Am J Surg Pathol 1989; 13: 21 - 7.

Epstein JI, Amin M, Boccon - Gibod L, et al. Prognostic factors and reporting of prostate carcinoma in radical prostatectomy and pelvic lymphadenectomy specimens. Scand J Nephrol Urol Suppl 2005; 216; 34 - 63.

Magi - Galuzzi C, Evans AJ, Delahunt B, Epstein JI, Griffiths GF, van der Kwast TH, et al.: International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease. Modern Pathology 2011; 24: 26 - 38.

Swanson GP, Basler JW: Prognostic factors for failure after prostatectomy. Journal of Cancer 2011; 2: 1 - 19.

Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC: Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol. 2003; 169:517 - 23.

Blute ML, Bergstralh EJ, Iocca A, Scherer B, Zincke H: Use of Gleason score, prostate specific antigen, seminal vesicle and margin status to predict biochemical failure after radical prostatectomy. J Urol. 2001; 165:119 - 25.

Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ: Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long - term results. J Urol. 2004;172:910 - 4.

Karakiewicz PI, Eastham JA, Graefen M, Cagiannos E, Stricker PD, Klein E, et al. Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi - institutional assessment of 5831 patients. Urology. 2005; 66: 1245 - 50.

Ravery V, Boccon - Gibod LA, Meulemans A, Dauge - Geffroy MC, Toublanc M, Boccon - Gibod L, et al.: Predictive value of pathological features for progression after radical prostatectomy. Eur Urol 1994; 26: 197 - 201.

Khan MA, Partin AW: Management of High - risk populations with locally advanced prostate cancer. The Oncologist 2003; 8: 259 - 69.

Potter SR, Epstein JI, Partin AW: Seminal vesicle invasion: Significance and therapeutic implications. Rev Urol 2000; 2 (3): 190 - 5.

Epstein JL, Carmichael M, Walsh PC: Adenocarcinoma of the prostate invading the seminal vesicle: definition and relation of tumor volume, grade and margins of resection to prognosis. J Urol 1993; 149: 1040 - 5.

Ohori M, Wheeler TM, Kattan MW, Goto Y, Scardino PT: Prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 1995; 154: 1818 - 24.

Salomon L, Anastasiadis AG, Johnson CW, McKiernan JM, Goluboff ET, Abbou CC et al.: Seminal vesicle involvement after radical prostatectomy: predicting risk factors for progression. Urology 2003; 62: 304 - 9.

Epstein JL, Partin AW, Potter SW, Walsh PC: Adenocarcinoma of the prostate invading the seminal vesicle: prognostic stratification based on pathologic parameters. Urology 2000; 56: 283 - 8.

Guzzo TJ, Vira MA, Neway W, Hwang WT, Tomasszewski J, van Arsdalen K et al.: Minimal tumor volume may provide additional prognostic information in good performance patients after radical prostatectomy. Urology 2007; 69(6): 1147 - 51.

Chun FK, Briganti A, Jedres C, Gallina A, Erbersdopler A, Schlomm T et al.: Tumor volume and high grade tumor volume are the best predictors of pathologic stage and biochemical recurrence after radical prostatectomy. Eur J Cancer 2007; 43(3): 536 - 43.

Salomon L, Levrel O, Anastasiadis AG, Irani J, de la Taille A, Saint F, et al.: Prognostic significance of tumor volume after radical prostatectomy: a multivariate analysis of pathological prognostic factors. Eur Urol 2003; 43: 39 - 44.

Rampersaud EN, Sun L, Moul JW, Madden J, Freedland SJ: Percent tumor involvement and risk of biochemical progression after radical prostatectomy. J Urol 2008; 180: 571 - 6.

Thompson IM, Salem S, Chang SS, Clark PE, Davis R, Herrell SD, et al.: Tumor volume as a predictor of adverse pathologic features and biochemical recurrence (BCR) in radical prostatectomy specimens: a tale of two methods. World J Urol 2011; 29: 15 - 20.

Endrizzi J, Seay T: The relationship between early biochemical failure and perineural invasion in pathological T2 prostate cancer. Br J Urol 2000; 85: 696 - 9.

Epstein JI. The role of perineural invasion and other bio - characteristics as prognostic markers for localized prostate cancer. Sem Urol Oncol. 1998; 16:124 - 8.

Brooks JP, Albert PS, O’Connell J, McLeod DG, Poggi MM: Lymphovascular invasion in prostate cancer: prognostic significance in patients treated with radiotherapy after radical prostatectomy. Cancer 2006; 106: 1521 - 6.

Shariat SF, Khoddami SM, Saboorian H, Koeneman KS, Sagalowsky AI, Caddedru JA, et al.: Lymphovascular invasion is a pathological feature of biologically aggressive disease in patients treated with radical prostatectomy. J Urol 2004; 171: 1122 - 7.

May M, Kaufmann O, Hammermann F, Loy V, Siegsmund M: Prognostic impact of lymphovascular invasion in radical prostatectomy specimens. BJU Int: 2006; 99: 539 - 44.

Herman CM, Wilcox GE, Kattan MW, Scardino PT, Wheeler TM: Lymphovascular invasion as a predictor of disease progression in prostate cancer. Am J Surg Pathol 2000; 24: 859 - 63.

De la Taille A, Rubin MA, Buttyan R, Olsson CA, Bagiella E, Burchardt T, et al.: Is microvascular invasion on radical prostatectomy specimen a useful predictor of PSA recurrence for prostate cancer patients? Eur Urol 2000; 38: 79 - 84.

Van den Ouden D, Kranse R, Hop WC, van der Kwast TH, Schroder FH: Microvascular invasion in prostate cancer: prognostic significance in patients treated by radical prostatectomy for clinically localized carcinoma. Urol Int 1998; 60: 17 - 24.

Cheng L, Jones TD, Lin H, Eble JN, Zeng G, Carr MD, et al. Lymphovascular invasion is an independent prognostic factor in prostatic adenocarcinoma. J Urol 2005; 174: 2181 - 5.

Yee DS, Shariat SF, Lowrance WT, Maschino AC, Savage CJ, Cronin AM, et al.: Prognostic significance of lymphovascular invasion in radical prostatectomy specimens. BJU Int 2011; 108 (4): 502 - 7.

Srigley JR. Key issues in handling and reporting radical prostatectomy specimens. Arch Pathol Lab Med 2006; 130: 303 - 17.

Lawretschuk N, Trottier G, Kuk C, Zlotta AR: Role of surgery in high - risk localized prostate cancer. Urol Oncol 2010; 17 Suppl 2: 25 - 32.

Schroder FH, Kurth KH, Fossa SD, Hoekstra W, Karthhaus PP, De Prijck L, et al.: Early versus delayed endocrine treatment of T2 - T3 pN1 - 3 M0 prostate cancer without local treatment of the primary tumour: final results of European Organisation for the Research and Treatment of Cancer protocol 30846 after 13 years of follow - up (a randomized controlled trial). Eur Urol 2009; 55: 14 - 22.

Cheng L, Zincke H, Blute ML, Bergstrahl EJ, Scherer B, Bostwick DG: Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer 2001; 91(1): 66 - 73.

Engel J, Bastian PJ, Baur H, Beer V, Chaussy C, Gschwend JE: Survival benefit of radical prostatectomy in lymph node - positive patients with prostate cancer. Eur Urol 2010; 57: 754 - 61.

Adams J, Cheng L: Lymph node - positive prostate cancer: current issues, emerging technology and impact on clinical outcome. Expert Rev Anticancer Ther 2011; 11(9): 1457 - 69.

Zhou P, Chen MH, McLeod D, Caroll PR, Moul JW, D’Amico AV: Predictors of prostate cancer specific mortality after radical prostatectomy or radiation therapy. J Clin Oncol 2005; 23: 6992 - 8.

Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC: Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281: 1591 - 7.

D’ Amico AV, Chen MH, Roehl KA, Catalona WJ: Identifying patients at risk for significant versus clinically insignificant postoperative prostate - specific antigen failure. J Clin Oncol 2005; 23: 4975 - 9.

D’Amico AV, Moul JW, Carroll PR, Sun L, Lubeck D, Chen MH: Surrogate end point for prostate cancer specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst 2003; 95: 1376 - 83.




DOI: http://dx.doi.org/10.19264/hj.v28i1.117