Subclassification of high-risk clinically organ-confined prostate cancer for early cancer-specific mortality after radical pros

High-risk clinically localized prostate cancer is seen in a highly heterogeneous population with a wide variation of clinical aggressiveness and a novel subclassification for the better prediction of clinical outcomes is needed. The aim of this study is to validate a modified D'Amico risk criteria for substratification of high-risk prostate cancer with regard to the prediction of biochemical recurrence, clinical progression-free survival or prostate cancer-specific mortality after radical prostatectomy. We conducted a retrospective multicenter cohort study including 461 clinically organconfined (cT1-2), D'Amico high-risk prostate cancer patients who underwent radical prostatectomy with pelvic lymph node dissection. The modified criteria subclassified D'Amico high-risk patients into high-risk (n = 189, single high-risk parameter and two low-risk parameters) and very high-risk (n = 272, at least one more intermediate or high-risk parameter in addition to the qualifying high-risk parameter) groups. Biochemical recurrence-free survival, clinical progression-free survival, prostate cancer-specific mortality and overall survival were analyzed. The very high-risk group, compared with high-risk group, had significantly poorer biochemical recurrence (5and 10-year biochemical recurrence-free rates: 52.8 vs 73.9% and 42.1 vs 61.7%, respectively, P < 0.0001), clinical progression-free survival (5and 10-year survivals: 91.8 vs 98.2% and 80.5 vs 98.2%, respectively, P = 0.0013) and prostate cancer-specific mortality (5and 10-year mortalities: 2.5 vs 0.0% and 6.7 vs 0.0%, respectively, P = 0.0124). D'Amico high-risk patients can achieve very favorable outcomes unless they are classified as very high risk. Our novel subclassification method is very simple and useful for better patient counseling and decision-making in the pretreatment setting. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected]. biochemical recurrence; clinical progression; prostate cancer–specific mortality; prostatic neoplasms; risk groups PMID: 27207889 DOI: 10.1093/jjco/hyw061 [PubMed as supplied by publisher] Format: Abstract 1 2 3 1 1 1 1 3 2 4 Author information Full text links Subclassification of high-risk clinically organ-confined prostate cancer... http://www.ncbi.nlm.nih.gov/pubmed/27207889?dopt=Abstract 1 di 2 27/07/2016 18.41