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Predictive factors for biochemical recurrence after robot assisted radical prostatectomy: Does ISUP grade and prostate size matter?
14th Meeting of the EAU Robotic Urology Section
PE50
Predictive factors for biochemical recurrence after robot assisted radical prostatectomy: Does ISUP grade and prostate size matter? Eur Urol Suppl 2017; 16(6);e2312
Van Domburg J. , Weijerman P. , Wijburg C. , Smits G. , Collette E. Rijnstate Hospital, Dept. of Urology, Arnhem, Netherlands, The Introduction & Objectives: Several prognostic variables for biochemical recurrence (BCR) after robot assisted radical prostatectomy (RARP) are known. BCR after RARP is manifested by elevated levels of PSA, it indicates relapse of prostate cancer with possible metastases. Pre- and postoperative predictive factors for BCR can define patients who are at a higher risk. We analyse pathological weighed prostate size together with the well-established predictors for BCR and the recent introduced ISUP grades. Material & Methods: Retrospective analysis was performed. From January 2010 until December 2016, in total 955 patients diagnosed with clinical localised prostate carcinoma underwent RARP in our referral hospital. The procedures were performed by three surgeons of our hospital. 323 patients were excluded from analysis because of incomplete data. We evaluated 632 patients. Pre-operative PSA, pTumor stage, pGleason score, ISUP grades, positive surgical margins (PSM) and pathological prostate size were analysed. End variable BCR is defined as a two times consecutive PSA measurement of >0.2 µg/L. Results: 46% (293/632) of pts presented with high risk ≥pT3a and/or ISUP grade 3, 4 and 5 (≥pGl7b) disease. BCR occurred in 113/632 (17.9%) of the patients, with a mean follow up of 38 months. The mean time to BCR was 17.5 months (SD ±19.4). Multivariate Cox-regression analysis showed significance in several factors. A pre-operative PSA value >15,00 was a significant predictor for BCR (p=0.001). The ISUP grades differ in significance: ISUP grade 2 was not significantly associated (p=0.212) where ISUP grade 3 was significantly associated with BCR (p=0.001). Combined subgroup of ISUP 4 and 5 was significant associated with BCR (p<0.001; HR 8.009). A significant difference for BCR between pTumor stage 2abc and 3ab (p<0.001) was observed. Prostate size showed no significant result for BCR (p=0.256). PSM appeared not to be a significant predictor for BCR (p=0.343). Table 1: Multivariate Cox-regression analysis
Variable
Significance Exp(B) 95,0% CI for Exp(B)
PSA pre-operative
0,001
1,028 1,012 - 1,045
ISUP 1 (pGl 6) reference ISUP 2 (pGl 3+4)
0,212
1,621 0,760 - 3,459
ISUP 3 (pGl 4+3)
0,001
3,671 1,697 - 7,941
ISUP 4, 5 (pGl 8, 9, 10) <0,001
8,009 3,932 - 16,313
pT 2abc reference pT 3ab
<0,001
3,526 2,201 - 5,649
Prostate size
0,256
0,994 0,985 - 1,004
Eur Urol Suppl 2017; 16(6);e2312
14th Meeting of the EAU Robotic Urology Section
Positive surgical margin 0,343
1,229 0,803 - 1,879
Conclusions: With a mean follow-up time of 38 months, up to 82% of the 632 patients who underwent RARP were free of biochemical recurrence, despite our population consisted of 46% high risk patients with ≥pT3a and/or ISUP grade 3, 4 and 5 (≥pGl7b) disease. Risk factors for BCR were preoperative high PSA levels, ISUP grade 3 or higher and pT3 disease. One might take into account the significant difference for risk of BCR in ISUP grade 2 and 3 disease. In this analysis positive surgical margins were not an independent risk factor for BCR. Pathological prostate size was not an associated risk factor for BCR.
Eur Urol Suppl 2017; 16(6);e2313
PE50
Predictive factors for biochemical recurrence after robot assisted radical prostatectomy: Does ISUP grade and prostate size matter? Eur Urol Suppl 2017; 16(6);e2312
Van Domburg J. , Weijerman P. , Wijburg C. , Smits G. , Collette E. Rijnstate Hospital, Dept. of Urology, Arnhem, Netherlands, The Introduction & Objectives: Several prognostic variables for biochemical recurrence (BCR) after robot assisted radical prostatectomy (RARP) are known. BCR after RARP is manifested by elevated levels of PSA, it indicates relapse of prostate cancer with possible metastases. Pre- and postoperative predictive factors for BCR can define patients who are at a higher risk. We analyse pathological weighed prostate size together with the well-established predictors for BCR and the recent introduced ISUP grades. Material & Methods: Retrospective analysis was performed. From January 2010 until December 2016, in total 955 patients diagnosed with clinical localised prostate carcinoma underwent RARP in our referral hospital. The procedures were performed by three surgeons of our hospital. 323 patients were excluded from analysis because of incomplete data. We evaluated 632 patients. Pre-operative PSA, pTumor stage, pGleason score, ISUP grades, positive surgical margins (PSM) and pathological prostate size were analysed. End variable BCR is defined as a two times consecutive PSA measurement of >0.2 µg/L. Results: 46% (293/632) of pts presented with high risk ≥pT3a and/or ISUP grade 3, 4 and 5 (≥pGl7b) disease. BCR occurred in 113/632 (17.9%) of the patients, with a mean follow up of 38 months. The mean time to BCR was 17.5 months (SD ±19.4). Multivariate Cox-regression analysis showed significance in several factors. A pre-operative PSA value >15,00 was a significant predictor for BCR (p=0.001). The ISUP grades differ in significance: ISUP grade 2 was not significantly associated (p=0.212) where ISUP grade 3 was significantly associated with BCR (p=0.001). Combined subgroup of ISUP 4 and 5 was significant associated with BCR (p<0.001; HR 8.009). A significant difference for BCR between pTumor stage 2abc and 3ab (p<0.001) was observed. Prostate size showed no significant result for BCR (p=0.256). PSM appeared not to be a significant predictor for BCR (p=0.343). Table 1: Multivariate Cox-regression analysis
Variable
Significance Exp(B) 95,0% CI for Exp(B)
PSA pre-operative
0,001
1,028 1,012 - 1,045
ISUP 1 (pGl 6) reference ISUP 2 (pGl 3+4)
0,212
1,621 0,760 - 3,459
ISUP 3 (pGl 4+3)
0,001
3,671 1,697 - 7,941
ISUP 4, 5 (pGl 8, 9, 10) <0,001
8,009 3,932 - 16,313
pT 2abc reference pT 3ab
<0,001
3,526 2,201 - 5,649
Prostate size
0,256
0,994 0,985 - 1,004
Eur Urol Suppl 2017; 16(6);e2312
14th Meeting of the EAU Robotic Urology Section
Positive surgical margin 0,343
1,229 0,803 - 1,879
Conclusions: With a mean follow-up time of 38 months, up to 82% of the 632 patients who underwent RARP were free of biochemical recurrence, despite our population consisted of 46% high risk patients with ≥pT3a and/or ISUP grade 3, 4 and 5 (≥pGl7b) disease. Risk factors for BCR were preoperative high PSA levels, ISUP grade 3 or higher and pT3 disease. One might take into account the significant difference for risk of BCR in ISUP grade 2 and 3 disease. In this analysis positive surgical margins were not an independent risk factor for BCR. Pathological prostate size was not an associated risk factor for BCR.
Eur Urol Suppl 2017; 16(6);e2313