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PROGRESSION OUTCOMES AFTER RADICAL PROSTATECTOMY FOR MEN IN THEIR 30'S COMPARED TO OLDER MEN
Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008
method, and the impact of various clinicopathological factors on outcome ZDVDQDO\]HGXVLQJ&R[SURSRUWLRQDOKD]DUGUHJUHVVLRQPRGHOV RESULTS: A total of 1513 men underwent RP for high risk disease, with a median follow-up of 8.7 years. The most common reason WKDW SDWLHQWV ZHUH FODVVL¿HG DV KDYLQJ KLJK ULVN GLVHDVH UHPDLQHG clinical stage across the time period studied. Nevertheless, 858/1513 PHQ ZHUH IRXQG WR KDYH RUJDQFRQ¿QHG WXPRUV DW 53 7HQ \HDU FDQFHUVSHFL¿F VXUYLYDO &66 ZDV ZLWK RI SDWLHQWV without local recurrence (LR) and 55% free from biochemical recurrence %&5GH¿QHGDVD36$QJP/ ¿JXUH 2QPXOWLYDULDWHDQDO\VLV Gleason score on biopsy (HR 1.3, p=0.006) and at RP (HR1.4, p=0.006), pathological tumor stage (HR 1.8, p=0.04), positive lymph nodes (HR 2.3, p=0.02), and positive surgical margins (HR 2.1, p=0.008) predicted death from prostate cancer. Age, year of surgery, preoperative PSA, clinical stage, and the number of high risk features did not affect survival. Adjuvant hormonal therapy (n=356) decreased the risk of BCR (HR 0.36, p<0.0001), LR (HR 0.26, p<0.0001), and systemic progression (SP) (HR S EXWGLGQRWVLJQL¿FDQWO\LPSDFWWKHULVNRI&66 +5 p=0.11) or overall survival (OS) (HR 0.87, p=0.39). CONCLUSIONS: RP for men with high risk prostate cancer facilitates accurate pathological staging, provides durable local control, and may offer long-term CSS. The challenge remains to identify FDQGLGDWHV ZKR ZRXOG PRVW EHQH¿W IURP D PXOWLPRGDO WUHDWPHQW approach.
Source of Funding: None
1619 PROGRESSION OUTCOMES AFTER RADICAL PROSTATECTOMY FOR MEN IN THEIR 30’S COMPARED TO OLDER MEN Stacy Loeb*, David J Hernandez, Leslie A Mangold, Elizabeth B Humphreys, Marilyn Agro, Patrick C Walsh, Alan W Partin, Misop Han. Baltimore, MD. INTRODUCTION AND OBJECTIVE: Previous studies have suggested that prostate cancer in young men may behave more aggressively. These reports have recently been refuted. There remains a scarcity of data on the biochemical outcome after radical prostatectomy VSHFL¿FDOO\IRUPHQLQWKHLU¶V METHODS: From a large (n=15,899) radical prostatectomy GDWDEDVH ZH LGHQWL¿HG PHQ DJHG DJHG DJHG DJHGWR DQGPHQ\HDUV old. The clinical characteristics and treatment outcomes were compared between men in their 30’s and older men. RESULTS: Among the men in their 30’s, 81% had organFRQ¿QHGGLVHDVHLQWKHUDGLFDOSURVWDWHFWRP\VSHFLPHQFRPSDUHGWR 62% of men aged 40 or older. At a mean follow-up of 5 years, biochemical progression occurred in 4.8% of men in their 30’s and 16.1% of men age \HDUV S 7KHFRUUHVSRQGLQJ\HDUELRFKHPLFDOSURJUHVVLRQ free survival estimates were 95% for men in their 30’s, and 83% for men \HDUVROG S 2QPXOWLYDULDWHDQDO\VLVLQFUHDVLQJDJHZDVD VLJQL¿FDQWLQGHSHQGHQWSUHGLFWRURIELRFKHPLFDOSURJUHVVLRQ CONCLUSIONS: Contrary to earlier reports, in this surgical population men in their 30’s did not have more aggressive disease.
THE JOURNAL OF UROLOGY®
553
Instead, they had more favorable pathological features and progressionfree survival rates than their older counterparts. After controlling for other prognostic variables on multivariate analysis, age in the 30’s was independently associated with a lower risk of biochemical progression. These results suggest that early aggressive treatment for these patients with a long life-expectancy is associated with favorable long-term biochemical outcomes. Source of Funding: National Institutes of Health/National Cancer Institute SPORE Grant #3P50CA058236.
1620 PREDICTING RISK OF PROSTATE CANCER-SPECIFIC MORTALITY BASED ON CLINICOPATHOLOGIC FEATURES AT RADICAL PROSTATECTOMY Scott E Eggener*, Andrew J Stephenson, James A Eastham, Eric A Klein, Ofer Yossepowitch, Fernando J Bianco, Michael W Kattan, Peter T Scardino. New York, NY, Cleveland, OH, and Washington, DC. INTRODUCTION AND OBJECTIVE: A nomogram predicting WKHSUREDELOLW\RISURVWDWHVSHFL¿FDQWLJHQUHFXUUHQFH 36$U DIWHUUDGLFDO prostatectomy (RP) is widely used. However, PSAr does not necessarily portend adverse clinical sequelae and is loosely associated with prostate FDQFHUVSHFL¿F PRUWDOLW\ 3&60 GXH WR LWV YDULDEOH QDWXUDO KLVWRU\ Therefore, we endeavored to develop a nomogram predicting the risk of PCSM based on clinical and pathologic features present at RP. 0(7+2'6 8VLQJ &R[ SURSRUWLRQDO KD]DUGV UHJUHVVLRQ analysis, the clinical information obtained during RP and outcomes of 5,535 patients treated at two tertiary care hospitals were modeled to predict the risk of PCSM. The model was validated on 3,709 patients treated with RP at a separate institution. The median (interquartile range) follow-ups of the modeling and validation cohorts were 49 (24-88) months and 46 (17-89) months, respectively. A concordance index (CI) was generated by comparing the probability of PCSM calculated by the nomogram with the actual outcome of patients in the validation set. RESULTS: The 15-year PCSM and all-cause mortality were 7% and 37%, respectively. The risks of PCSM at 15 years for patients with Gleason 2-6, 7, and 8-10 cancers were 2%, 7%, and 49%, respectively. Based on pathologic stage, the risks of PCSM at 15 years for patients ZLWKRUJDQFRQ¿QHGGLVHDVHH[WUDFDSVXODUH[WHQVLRQVHPLQDOYHVLFOH invasion and lymph node metastasis were 2%, 7%, 27%, and 22%, respectively. In multivariable analysis, primary and secondary Gleason grade (p < .001 for both), seminal vesicle invasion (p = .002), and year of surgery (p ZHUHVLJQL¿FDQWSUHGLFWRUVRI3&60$QRPRJUDP based on 7 clinical and pathologic parameters predicting the 13-year risk of PCSM was accurate and discriminating with a CI of 0.92. CONCLUSIONS: We have developed and externally validated a robust model that accurately predicts the risk of PCSM at 13 years after RP. The presence of poorly differentiated disease is the prime determinant of PCSM.
Source of Funding: None
method, and the impact of various clinicopathological factors on outcome ZDVDQDO\]HGXVLQJ&R[SURSRUWLRQDOKD]DUGUHJUHVVLRQPRGHOV RESULTS: A total of 1513 men underwent RP for high risk disease, with a median follow-up of 8.7 years. The most common reason WKDW SDWLHQWV ZHUH FODVVL¿HG DV KDYLQJ KLJK ULVN GLVHDVH UHPDLQHG clinical stage across the time period studied. Nevertheless, 858/1513 PHQ ZHUH IRXQG WR KDYH RUJDQFRQ¿QHG WXPRUV DW 53 7HQ \HDU FDQFHUVSHFL¿F VXUYLYDO &66 ZDV ZLWK RI SDWLHQWV without local recurrence (LR) and 55% free from biochemical recurrence %&5GH¿QHGDVD36$QJP/ ¿JXUH 2QPXOWLYDULDWHDQDO\VLV Gleason score on biopsy (HR 1.3, p=0.006) and at RP (HR1.4, p=0.006), pathological tumor stage (HR 1.8, p=0.04), positive lymph nodes (HR 2.3, p=0.02), and positive surgical margins (HR 2.1, p=0.008) predicted death from prostate cancer. Age, year of surgery, preoperative PSA, clinical stage, and the number of high risk features did not affect survival. Adjuvant hormonal therapy (n=356) decreased the risk of BCR (HR 0.36, p<0.0001), LR (HR 0.26, p<0.0001), and systemic progression (SP) (HR S EXWGLGQRWVLJQL¿FDQWO\LPSDFWWKHULVNRI&66 +5 p=0.11) or overall survival (OS) (HR 0.87, p=0.39). CONCLUSIONS: RP for men with high risk prostate cancer facilitates accurate pathological staging, provides durable local control, and may offer long-term CSS. The challenge remains to identify FDQGLGDWHV ZKR ZRXOG PRVW EHQH¿W IURP D PXOWLPRGDO WUHDWPHQW approach.
Source of Funding: None
1619 PROGRESSION OUTCOMES AFTER RADICAL PROSTATECTOMY FOR MEN IN THEIR 30’S COMPARED TO OLDER MEN Stacy Loeb*, David J Hernandez, Leslie A Mangold, Elizabeth B Humphreys, Marilyn Agro, Patrick C Walsh, Alan W Partin, Misop Han. Baltimore, MD. INTRODUCTION AND OBJECTIVE: Previous studies have suggested that prostate cancer in young men may behave more aggressively. These reports have recently been refuted. There remains a scarcity of data on the biochemical outcome after radical prostatectomy VSHFL¿FDOO\IRUPHQLQWKHLU¶V METHODS: From a large (n=15,899) radical prostatectomy GDWDEDVH ZH LGHQWL¿HG PHQ DJHG DJHG DJHG DJHGWR DQGPHQ\HDUV old. The clinical characteristics and treatment outcomes were compared between men in their 30’s and older men. RESULTS: Among the men in their 30’s, 81% had organFRQ¿QHGGLVHDVHLQWKHUDGLFDOSURVWDWHFWRP\VSHFLPHQFRPSDUHGWR 62% of men aged 40 or older. At a mean follow-up of 5 years, biochemical progression occurred in 4.8% of men in their 30’s and 16.1% of men age \HDUV S 7KHFRUUHVSRQGLQJ\HDUELRFKHPLFDOSURJUHVVLRQ free survival estimates were 95% for men in their 30’s, and 83% for men \HDUVROG S 2QPXOWLYDULDWHDQDO\VLVLQFUHDVLQJDJHZDVD VLJQL¿FDQWLQGHSHQGHQWSUHGLFWRURIELRFKHPLFDOSURJUHVVLRQ CONCLUSIONS: Contrary to earlier reports, in this surgical population men in their 30’s did not have more aggressive disease.
THE JOURNAL OF UROLOGY®
553
Instead, they had more favorable pathological features and progressionfree survival rates than their older counterparts. After controlling for other prognostic variables on multivariate analysis, age in the 30’s was independently associated with a lower risk of biochemical progression. These results suggest that early aggressive treatment for these patients with a long life-expectancy is associated with favorable long-term biochemical outcomes. Source of Funding: National Institutes of Health/National Cancer Institute SPORE Grant #3P50CA058236.
1620 PREDICTING RISK OF PROSTATE CANCER-SPECIFIC MORTALITY BASED ON CLINICOPATHOLOGIC FEATURES AT RADICAL PROSTATECTOMY Scott E Eggener*, Andrew J Stephenson, James A Eastham, Eric A Klein, Ofer Yossepowitch, Fernando J Bianco, Michael W Kattan, Peter T Scardino. New York, NY, Cleveland, OH, and Washington, DC. INTRODUCTION AND OBJECTIVE: A nomogram predicting WKHSUREDELOLW\RISURVWDWHVSHFL¿FDQWLJHQUHFXUUHQFH 36$U DIWHUUDGLFDO prostatectomy (RP) is widely used. However, PSAr does not necessarily portend adverse clinical sequelae and is loosely associated with prostate FDQFHUVSHFL¿F PRUWDOLW\ 3&60 GXH WR LWV YDULDEOH QDWXUDO KLVWRU\ Therefore, we endeavored to develop a nomogram predicting the risk of PCSM based on clinical and pathologic features present at RP. 0(7+2'6 8VLQJ &R[ SURSRUWLRQDO KD]DUGV UHJUHVVLRQ analysis, the clinical information obtained during RP and outcomes of 5,535 patients treated at two tertiary care hospitals were modeled to predict the risk of PCSM. The model was validated on 3,709 patients treated with RP at a separate institution. The median (interquartile range) follow-ups of the modeling and validation cohorts were 49 (24-88) months and 46 (17-89) months, respectively. A concordance index (CI) was generated by comparing the probability of PCSM calculated by the nomogram with the actual outcome of patients in the validation set. RESULTS: The 15-year PCSM and all-cause mortality were 7% and 37%, respectively. The risks of PCSM at 15 years for patients with Gleason 2-6, 7, and 8-10 cancers were 2%, 7%, and 49%, respectively. Based on pathologic stage, the risks of PCSM at 15 years for patients ZLWKRUJDQFRQ¿QHGGLVHDVHH[WUDFDSVXODUH[WHQVLRQVHPLQDOYHVLFOH invasion and lymph node metastasis were 2%, 7%, 27%, and 22%, respectively. In multivariable analysis, primary and secondary Gleason grade (p < .001 for both), seminal vesicle invasion (p = .002), and year of surgery (p ZHUHVLJQL¿FDQWSUHGLFWRUVRI3&60$QRPRJUDP based on 7 clinical and pathologic parameters predicting the 13-year risk of PCSM was accurate and discriminating with a CI of 0.92. CONCLUSIONS: We have developed and externally validated a robust model that accurately predicts the risk of PCSM at 13 years after RP. The presence of poorly differentiated disease is the prime determinant of PCSM.
Source of Funding: None