Oncologic and Functional Outcomes after Radical Prostatectomy for High or Very High Risk Prostate Cancer: European Validation of the Current NCCN® Guideline

No AccessJournal of UrologyAdult Urology1 Aug 2017Oncologic and Functional Outcomes after Radical Prostatectomy for High or Very High Risk Prostate Cancer: European Validation of the Current NCCN® Guideline Raisa S. Pompe, Pierre I. Karakiewicz, Zhe Tian, Philipp Mandel, Thomas Steuber, Thorsten Schlomm, Georg Salomon, Markus Graefen, Hartwig Huland, and Derya Tilki Raisa S. PompeRaisa S. Pompe Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada , Pierre I. KarakiewiczPierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada , Zhe TianZhe Tian Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada , Philipp MandelPhilipp Mandel Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Thomas SteuberThomas Steuber Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Thorsten SchlommThorsten Schlomm Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Georg SalomonGeorg Salomon Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Markus GraefenMarkus Graefen Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Hartwig HulandHartwig Huland Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany , and Derya TilkiDerya Tilki Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.070AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We validated the current NCCN (National Comprehensive Cancer Network®) classification of very high risk patients, and compared the pathological, functional and oncologic outcomes between surgically treated high risk and very high risk patients. Materials and Methods: We retrospectively analyzed 4,041 patients stratified into high risk or very high risk groups who underwent radical prostatectomy between 1992 and 2016. Kaplan-Meier as well as multivariable logistic and Cox regression analyses were used to compare outcomes between the groups. Results: After radical prostatectomy the rate of adverse pathological features was higher in 1,369 very high risk vs 2,672 high risk cases. Functional outcomes were similar between the groups, with 1-year continence and potency rates of 81.0% and 43.6% in the very high risk compared to 81.9% and 45.2% in the high risk group, respectively (p = 0.7 and p = 0.9). In a subset of 1,835 patients who underwent radical prostatectomy between 1992 and 2011 (median followup 58.8 months, IQR 36.5–84.6), those with very high risk disease had significantly worse 5 and 8-year biochemical recurrence-free survival, metastatic progression-free survival, prostate cancer specific mortality-free survival and overall survival rates compared to those with high risk disease. Conclusions: Despite the relatively poor prognosis of patients with high risk prostate cancer, radical prostatectomy results in favorable 5 and 8-year metastatic progression-free survival, prostate cancer specific mortality-free survival and overall survival rates. Relative to high risk cases, their very high risk counterparts have significantly worse pathological and oncologic outcomes, and more frequently require additional therapies. These observations validate the stratification between high risk and very high risk in European patients with prostate cancer. 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Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChierigo F, Wenzel M, Würnschimmel C, Flammia R, Horlemann B, Tian Z, Saad F, Chun F, Graefen M, Gallucci M, Shariat S, Mantica G, Borghesi M, Suardi N, Terrone C and Karakiewicz P (2021) Survival after Radical Prostatectomy versus Radiation Therapy in High-Risk and Very High-Risk Prostate CancerJournal of Urology, VOL. 207, NO. 2, (375-384), Online publication date: 1-Feb-2022.Gorin M, Rowe S, Patel H, Vidal I, Mana-ay M, Javadi M, Solnes L, Ross A, Schaeffer E, Bivalacqua T, Partin A, Pienta K, Szabo Z, De Marzo A, Pomper M and Allaf M (2017) Prostate Specific Membrane Antigen Targeted 18F-DCFPyL Positron Emission Tomography/Computerized Tomography for the Preoperative Staging of High Risk Prostate Cancer: Results of a Prospective, Phase II, Single Center StudyJournal of Urology, VOL. 199, NO. 1, (126-132), Online publication date: 1-Jan-2018. Volume 198Issue 2August 2017Page: 354-361Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsprostatectomytreatment outcomeprostatic neoplasmsriskMetricsAuthor Information Raisa S. Pompe Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Zhe Tian Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Philipp Mandel Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Thomas Steuber Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Thorsten Schlomm Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Georg Salomon Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Markus Graefen Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Hartwig Huland Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Derya Tilki Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Expand All Advertisement PDF downloadLoading ...