Changing Nature of High Risk Patients Undergoing Radical Prostatectomy

No AccessJournal of UrologyAdult urology1 Jan 2007Changing Nature of High Risk Patients Undergoing Radical Prostatectomy Christopher J. Kane, Joseph C. Presti, Christopher L. Amling, William J. Aronson, Martha K. Terris, Stephen J. Freedland, and SEARCH Database Study Group Christopher J. KaneChristopher J. Kane Urology Section, Department of Surgery, Veterans Administration Medical Center San Francisco, San Francisco Department of Urology, University of California, San Francisco School of Medicine, San Francisco More articles by this author , Joseph C. PrestiJoseph C. Presti Department of Urology, Stanford University School of Medicine and Urology Section, Department of Surgery, Veterans Administration Medical Center Palo Alto, Palo Alto More articles by this author , Christopher L. AmlingChristopher L. Amling Department of Urology, San Diego Naval Hospital, San Diego More articles by this author , William J. AronsonWilliam J. Aronson Urology Section, Department of Surgery, Veterans Administration Greater Los Angeles Healthcare System and Department of Urology, University of California, Los Angeles School of Medicine, Los Angeles, California More articles by this author , Martha K. TerrisMartha K. Terris Department of Surgery, Veterans Administration Medical Center Augusta and Section of Urology, Medical College of Georgia, Augusta, Georgia More articles by this author , Stephen J. FreedlandStephen J. Freedland Department of Surgery, Veterans Administration Medical Center Durham and Division of Urologic Surgery, Departments of Surgery and Pathology and Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina More articles by this author , and SEARCH Database Study Group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2006.08.057AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We examined the outcomes of radical prostatectomy alone in high risk patients with prostate cancer and evaluated changes in high risk prostate cancer outcomes with time. Materials and Methods: From 1988 to 2003, 251 men with high risk prostate cancer (prostate specific antigen more than 20 ng/ml and/or biopsy Gleason greater than 7) were identified in a cohort of 1,796 (14%) enrolled in the Shared Equal Access Regional Cancer Hospital Database. Temporal changes in clinicopathological characteristics and prostate specific antigen recurrence rates were examined stratified by 4, 4-year periods. Results: With time significantly more men were considered at high risk due to a high biopsy Gleason score relative to prior years, when the most common reason for being considered at high risk was increased PSA (p <0.001). Only 3% of high risk men from 2000 to 2003 had increased prostate specific antigen and high biopsy Gleason score compared to 23% from 1988 to 1991. With time there were no differences in biochemical recurrence rates (p = 0.147). Men with a high biopsy Gleason score and increased prostate specific antigen had worse outcomes than men with only a high Gleason score or men with only high prostate specific antigen (p = 0.046 and 0.081, respectively). On multivariate analysis that only included preoperative clinical characteristics only prostate specific antigen was an independent predictor of prostate specific antigen failure following radical prostatectomy (p = 0.014). There was a trend, which did not attain statistical significance, for higher biopsy Gleason scores and higher clinical stage to be associated with higher failure rates (p = 0.060 and 0.081, respectively). Conclusions: Patients are designated as high risk by Gleason grade more commonly now than early in the prostate specific antigen era. Outcomes in high risk patients undergoing radical prostatectomy alone have not significantly improved with time. New treatment strategies, such as multimodality therapy, are needed to improve outcomes in high risk patients with prostate cancer. References 1 : Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE). J Urol2003; 170: S21. 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A Cohort Analysis From the SEARCH DatabaseJournal of Urology, VOL. 187, NO. 6, (2056-2060), Online publication date: 1-Jun-2012.Gofrit O, Zorn K, Steinberg G, Zagaja G and Shalhav A (2018) The Will Rogers Phenomenon in Urological OncologyJournal of Urology, VOL. 179, NO. 1, (28-33), Online publication date: 1-Jan-2008.Boorjian S, Karnes R, Rangel L, Bergstralh E and Blute M (2018) Mayo Clinic Validation of the D’Amico Risk Group Classification for Predicting Survival Following Radical ProstatectomyJournal of Urology, VOL. 179, NO. 4, (1354-1361), Online publication date: 1-Apr-2008. Volume 177Issue 1January 2007Page: 113-117 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordsprostatectomyprostateoutcome assessment (health care)adenocarcinomaprostate-specific antigenMetricsAuthor Information Christopher J. Kane Urology Section, Department of Surgery, Veterans Administration Medical Center San Francisco, San Francisco Department of Urology, University of California, San Francisco School of Medicine, San Francisco More articles by this author Joseph C. Presti Department of Urology, Stanford University School of Medicine and Urology Section, Department of Surgery, Veterans Administration Medical Center Palo Alto, Palo Alto More articles by this author Christopher L. Amling Department of Urology, San Diego Naval Hospital, San Diego More articles by this author William J. Aronson Urology Section, Department of Surgery, Veterans Administration Greater Los Angeles Healthcare System and Department of Urology, University of California, Los Angeles School of Medicine, Los Angeles, California More articles by this author Martha K. Terris Department of Surgery, Veterans Administration Medical Center Augusta and Section of Urology, Medical College of Georgia, Augusta, Georgia More articles by this author Stephen J. Freedland Department of Surgery, Veterans Administration Medical Center Durham and Division of Urologic Surgery, Departments of Surgery and Pathology and Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina More articles by this author SEARCH Database Study Group More articles by this author Expand All Advertisement PDF downloadLoading ...