The Impact of Clinical Stage on Prostate Cancer Survival Following Radical Prostatectomy

Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905.
The Journal of urology (Impact Factor: 4.47). 11/2012; 189(5). DOI: 10.1016/j.juro.2012.11.065
Source: PubMed


Clinical stage has been incorporated into multiple risk stratification models for patients with newly diagnosed prostate cancer. However, the independent prognostic value of this variable remains open to debate. In this study we evaluated the association of clinical stage with death from prostate cancer in men who underwent radical prostatectomy and assessed for changes in its prognostic value over time.

Materials and methods:
We reviewed the records of 14,842 consecutive patients who underwent radical prostatectomy at our institution between 1970 and 2008 without having received preoperative hormone or radiation therapy. Postoperative disease recurrence was estimated using the Kaplan-Meier method and compared using the log rank test. Multivariate Cox proportional hazard regression models were used to analyze the association of clinical stage with outcome.

A total of 5,725 (38.6%) men were classified as having cT1 tumors, 8,160 (55.0%) cT2 tumors and 957 (6.4%) cT3 disease. On univariate analysis clinical stage was significantly associated with postoperative biochemical recurrence, systemic progression and death from prostate cancer (p <0.001 for each). Moreover on multivariate analysis clinical stage was significantly associated with death from cancer for patients treated before (1.45, p = 0.006) and those treated during (1.96, p <0.001) the prostate specific antigen era. Furthermore, the incorporation of clinical stage into contemporary risk stratification improved the prediction of cancer specific survival (c statistic 0.782 without and 0.802 with clinical stage).

Clinical stage is significantly associated with systemic progression and death from prostate cancer. Inclusion of this variable in multivariate prediction models improves the prediction of systemic progression and cancer specific survival.

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    • "Accurate clinical staging is important for managing prostate cancer. Compared with organ-confined disease, prostate cancer with extracapsular extension (ECE) is associated with decreased overall and cancer-specific survival following radical prostatectomy [1] [2]. Moreover, even the extent of ECE predicts disease recurrence and survival [3] [4]. "
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    ABSTRACT: To define the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for identifying focal and established extracapsular extension (ECE) in various zones of the prostate. Between 2010 and 2013, 342 patients underwent MP-MRI of the prostate (3T, no endorectal coil with axial perfusion and diffusion images). The findings of the images were reported as negative, suspicious, or positive for ECE by a single expert radiologist. Radical prostatectomy specimens were reviewed to confirm the size and the location of ECE and further defined as focal or established ECE. Established ECE included extension that was multifocal or involving more than 5 glands. The accuracy of MRI in localizing focal and established ECE to each zone of the prostate was determined. Regression analyses were performed to identify predictors of ECE. We identified 112 patients who underwent prostate MP-MRI and radical prostatectomy. MRI findings considered suspicious or definite for ECE accurately predicted pathologic ECE (P<0.001). MP-MRI identified established ECE but not focal ECE. Sensitivity, specificity, positive predictive value, and negative predictive value of MP-MRI for established ECE were 70.7%, 90.6%, 57.1%, and 95.1%, respectively. MRI identified ECE to the left vs. right side as well as each zone of the prostate; however, sensitivity was lowest at the apex. On multivariate analysis, MRI was a significant predictor of ECE that was independent of prostate-specific antigen level, Gleason score, and clinical stage. MP-MRI is useful for identifying established but not focal ECE in all zones of the prostate. MRI was a significant independent predictor of established ECE and may be a useful adjunct in staging prostate cancer. Copyright © 2014 Elsevier Inc. All rights reserved.
    Urologic Oncology 12/2014; 33(3). DOI:10.1016/j.urolonc.2014.11.007 · 2.77 Impact Factor
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    • "Identifying the subset of patients with aggressive disease at the time of surgery (radical prostatectomy, RP) may allow for the use of more tailored therapeutic strategies. The probability of recurrent disease has been predicted on the basis of preoperative serum prostate-specific antigen (PSA) levels, sex steroids levels and other clinicopathological parameters such as tumor stage, biopsy Gleason score and surgical margins12345678910. Integration of gene expression profiling and clinical variables has increased prediction accuracy for recurrent and aggressive disease1112. "
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    ABSTRACT: Metastasis-associated protein 1 (MTA1), a negative epigenetic modifier, plays a critical role in prostate cancer (PCa) progression. We hypothesized that MTA1 overexpression in primary tumor tissues can predict PCa aggressiveness and metastasis. Immunohistochemical staining of MTA1 was done on archival PCa specimens from University of Mississippi Medical Center and University of Iowa. We found that nuclear MTA1 overexpression was positively correlated with the severity of disease progression reaching its highest levels in metastatic PCa. Nuclear MTA1 overexpression was significantly associated with Gleason > 7 tumors in African Americans but not in Caucasians. It was also a predictor of recurrent disease. We concluded that MTA1 nuclear overexpression may be a prognostic indicator and a future therapeutic target for aggressive PCa in African American men. Our findings may be useful for categorizing African American patients with a higher probability of recurrent disease and metastasis from those who are likely to remain metastasis-free.
    Scientific Reports 07/2013; 3(8 Supplement):2331. DOI:10.1038/srep02331 · 5.58 Impact Factor
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    ABSTRACT: Prostate cancer (PC) is one of the most common cancers in the male population worldwide. Focal therapy for PC is now considered an emerging alternative to active surveillance for the management of low-risk PC, with the overall aim of treating only areas of cancer, minimizing lifetime morbidity without compromising life expectancy. One option within focal therapy, high intensity focused ultrasound (HIFU), represents an innovative technique that may selectively ablate known the disease while preserving existing functions. In the last 10 years, the feasibility and the safety of US guided HIFU has been tested in a growing number of clinical studies. More recently, magnetic resonance imaging was combined with HIFU principle and was presented as a novel technique for focal ablation of PC. In this review we introduce the technology of Magnetic Resonance guided Focused Ultrasound (MRgFUS) and the current status of clinical applications in the therapy of PC.
    06/2013; 1(2). DOI:10.1007/s40134-013-0011-2
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