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MP40-08 INFLUENCE OF PATHOLOGIST ON POSITIVE SURGICAL MARGINS FOLLOWING RADICAL PROSTATECTOMY: ANALYSIS OF 3,557 CASES
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
e553
MP40-07
MP40-08
LONG-TERM FOLLOW-UP DATA AFTER RADICAL PROSTATECTOMY: DETERMINING WHEN TO STOP PSA MONITORING
INFLUENCE OF PATHOLOGIST ON POSITIVE SURGICAL MARGINS FOLLOWING RADICAL PROSTATECTOMY: ANALYSIS OF 3,557 CASES
Kazuhiro Matsumoto*, Akari Komatsuda, Yoshinori Yanai, Takeo Kosaka, Eiji Kikuchi, Akira Miyajima, Mototsugu Oya, Tokyo, Japan
Jacob E. Tallman*, Vignesh T. Packiam, Gladell P. Paner, Scott E. Eggener, Chicago, IL
INTRODUCTION AND OBJECTIVES: Most patients who fail treatment for prostate cancer do so early, and these patients should therefore be followed up more closely during the first years after radical prostatectomy. Most often, for monitoring of cancer recurrence, serum prostate specific antigen (PSA) is obtained at three- to sixmonth intervals for the first three years, and annually thereafter. However, tumor or patient characteristics may allow alterations to this schedule. In this study, we analyzed our long-term follow-up data after radical prostatectomy, and determined how long we should follow the patients whose PSA level continuously remains low. METHODS: We retrospectively reviewed clinicopathological data in 582 consecutive patients who underwent radical prostatectomy between 1995 and 2004, excluding 4 patients who received adjuvant therapy. We stratified the patients according to their PSA levels at 3 and 5 years after surgery, and examined subsequent biochemical recurrence. Biochemical recurrence was defined as the elevation of PSA to above 0.2 ng/mL. The mean follow-up interval was 9.7 years. RESULTS: At 3 years after surgery, PSA levels were measured by ultra-sensitive assay in 323 patients who did not experience biochemical recurrence at that time, and we divided them into 4 groups according to their PSA levels (PSA <0.01 ng/mL, 0.01-0.05, 0.06-0.09, 0.10-0.20). In 187 patients with undetectable PSA (<0.01 ng/mL), the 10- and 15-year biochemical recurrence-free survivals were 99% and 96%, respectively. At 5 years after surgery, PSA levels were checked by ultra-sensitive assay in 315 patients, and again they were stratified into 4 groups. In 162 patients with PSA <0.01 ng/mL, the 10- and 15year biochemical recurrence-free survivals were both 100% (Figure 1). Their PSA levels at the last follow-up were <0.01 ng/mL in 130 patients, 0.01-0.03 ng/mL in 27 patients, and 0.06 ng/mL, 0.07 ng/mL, and 0.11 ng/mL in one patient each. CONCLUSIONS: PSA determined by ultra-sensitive assay is an important parameter after radical prostatectomy, and useful for predicting the subgroups of patients most likely and unlikely to exhibit biochemical recurrence. Our long-term follow-up data indicated that PSA monitoring of patients with continuous undetectable level of PSA for 5 years could be stopped with an extremely limited risk of later biochemical recurrence.
INTRODUCTION AND OBJECTIVES: A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer (PCa) is associated with an increased risk of biochemical recurrence. Studies have found inter-observer concordance for margins to be approximately 87-89%. We sought to examine whether the individual pathologist is an independent predictor of PSMs. METHODS: We performed a retrospective review of 3,557 men who underwent RP for localized PCa at our institution from 2003-2015. All men were assessed for baseline characteristics and pathologic variables. We evaluated 29 separate pathologists. Univariate logistic regression was used to test variables previously shown to influence PSM rates. Multivariable logistic regression was performed using the most significant predictors (p < 0.1). RESULTS: The overall rate of PSM was 18.9%. Compared to patients without PSM, patients with PSM had higher BMI (mean 28.8 vs. 28.3), Gleason 7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and mean PSA (7.9 vs. 6.2) (all p < 0.05). Univariate logistic regression showed less surgeon experience, greater pathologist experience, and pathologist GU fellowship training were all predictors for PSMs (all p < 0.05). After controlling for age, BMI, PSA, pathologic stage, Gleason score, and GU fellowship training, multivariable regression analysis confirmed decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher PSA were significant predictors for PSMs. Increasing surgeon experience was associated with decreased odds of PSM (OR 0.79, 95% CI [0.70 - 0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (OR 1.11, 95% CI [1.03 - 1.19]). The relationship between pathologist experience and PSM, controlled for case-mix, was non-linear (Figure 1). CONCLUSIONS: Pathologist experience is an independent factor for PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience.
Source of Funding: NIH NIDDK grant 5T35DK062719-28 NIH CTSA UL1 TR000430 Pritzker School of Medicine Source of Funding: none
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
e553
MP40-07
MP40-08
LONG-TERM FOLLOW-UP DATA AFTER RADICAL PROSTATECTOMY: DETERMINING WHEN TO STOP PSA MONITORING
INFLUENCE OF PATHOLOGIST ON POSITIVE SURGICAL MARGINS FOLLOWING RADICAL PROSTATECTOMY: ANALYSIS OF 3,557 CASES
Kazuhiro Matsumoto*, Akari Komatsuda, Yoshinori Yanai, Takeo Kosaka, Eiji Kikuchi, Akira Miyajima, Mototsugu Oya, Tokyo, Japan
Jacob E. Tallman*, Vignesh T. Packiam, Gladell P. Paner, Scott E. Eggener, Chicago, IL
INTRODUCTION AND OBJECTIVES: Most patients who fail treatment for prostate cancer do so early, and these patients should therefore be followed up more closely during the first years after radical prostatectomy. Most often, for monitoring of cancer recurrence, serum prostate specific antigen (PSA) is obtained at three- to sixmonth intervals for the first three years, and annually thereafter. However, tumor or patient characteristics may allow alterations to this schedule. In this study, we analyzed our long-term follow-up data after radical prostatectomy, and determined how long we should follow the patients whose PSA level continuously remains low. METHODS: We retrospectively reviewed clinicopathological data in 582 consecutive patients who underwent radical prostatectomy between 1995 and 2004, excluding 4 patients who received adjuvant therapy. We stratified the patients according to their PSA levels at 3 and 5 years after surgery, and examined subsequent biochemical recurrence. Biochemical recurrence was defined as the elevation of PSA to above 0.2 ng/mL. The mean follow-up interval was 9.7 years. RESULTS: At 3 years after surgery, PSA levels were measured by ultra-sensitive assay in 323 patients who did not experience biochemical recurrence at that time, and we divided them into 4 groups according to their PSA levels (PSA <0.01 ng/mL, 0.01-0.05, 0.06-0.09, 0.10-0.20). In 187 patients with undetectable PSA (<0.01 ng/mL), the 10- and 15-year biochemical recurrence-free survivals were 99% and 96%, respectively. At 5 years after surgery, PSA levels were checked by ultra-sensitive assay in 315 patients, and again they were stratified into 4 groups. In 162 patients with PSA <0.01 ng/mL, the 10- and 15year biochemical recurrence-free survivals were both 100% (Figure 1). Their PSA levels at the last follow-up were <0.01 ng/mL in 130 patients, 0.01-0.03 ng/mL in 27 patients, and 0.06 ng/mL, 0.07 ng/mL, and 0.11 ng/mL in one patient each. CONCLUSIONS: PSA determined by ultra-sensitive assay is an important parameter after radical prostatectomy, and useful for predicting the subgroups of patients most likely and unlikely to exhibit biochemical recurrence. Our long-term follow-up data indicated that PSA monitoring of patients with continuous undetectable level of PSA for 5 years could be stopped with an extremely limited risk of later biochemical recurrence.
INTRODUCTION AND OBJECTIVES: A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer (PCa) is associated with an increased risk of biochemical recurrence. Studies have found inter-observer concordance for margins to be approximately 87-89%. We sought to examine whether the individual pathologist is an independent predictor of PSMs. METHODS: We performed a retrospective review of 3,557 men who underwent RP for localized PCa at our institution from 2003-2015. All men were assessed for baseline characteristics and pathologic variables. We evaluated 29 separate pathologists. Univariate logistic regression was used to test variables previously shown to influence PSM rates. Multivariable logistic regression was performed using the most significant predictors (p < 0.1). RESULTS: The overall rate of PSM was 18.9%. Compared to patients without PSM, patients with PSM had higher BMI (mean 28.8 vs. 28.3), Gleason 7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and mean PSA (7.9 vs. 6.2) (all p < 0.05). Univariate logistic regression showed less surgeon experience, greater pathologist experience, and pathologist GU fellowship training were all predictors for PSMs (all p < 0.05). After controlling for age, BMI, PSA, pathologic stage, Gleason score, and GU fellowship training, multivariable regression analysis confirmed decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher PSA were significant predictors for PSMs. Increasing surgeon experience was associated with decreased odds of PSM (OR 0.79, 95% CI [0.70 - 0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (OR 1.11, 95% CI [1.03 - 1.19]). The relationship between pathologist experience and PSM, controlled for case-mix, was non-linear (Figure 1). CONCLUSIONS: Pathologist experience is an independent factor for PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience.
Source of Funding: NIH NIDDK grant 5T35DK062719-28 NIH CTSA UL1 TR000430 Pritzker School of Medicine Source of Funding: none