Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2008 May;179(5):1791-6; discussion 1796.
doi: 10.1016/j.juro.2008.01.043. Epub 2008 Mar 17.

Risk stratification for biochemical recurrence in men with positive surgical margins or extracapsular disease after radical prostatectomy: results from the SEARCH database

Jayakrishnan Jayachandran  1 , Lionel L Bañez, Donna E Levy, William J Aronson, Martha K Terris, Joseph C Presti Jr, Christopher L Amling, Christopher J Kane, Stephen J Freedland; SEARCH Database Study Group
Affiliations
Multicenter Study

Risk stratification for biochemical recurrence in men with positive surgical margins or extracapsular disease after radical prostatectomy: results from the SEARCH database

Jayakrishnan Jayachandran et al. J Urol. 2008 May.

Erratum in

  • J Urol. 2008 Nov;180(5):2263

Abstract

Purpose: In men with extracapsular disease or positive surgical margins after radical prostatectomy immediate adjuvant therapy decreases the risk of biochemical recurrence at the cost of increased toxicity. We further stratified these men into a low risk group in which watchful waiting after surgery may be preferred and a high risk cohort in which adjuvant therapy may be preferred.

Materials and methods: We performed a retrospective analysis of the records of 902 men treated with radical prostatectomy in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database between 1988 and 2007 with positive surgical margins and/or extracapsular disease without seminal vesicle invasion or lymph node metastasis. The significant independent predictors of biochemical recurrence were determined using a multivariate Cox proportional hazards model. Based on the recurrence risk generated from the multivariate Cox proportional hazards regression model we generated tables to estimate the risk of recurrence-free survival 1, 3 and 5 years after surgery.

Results: At a median of 3 years of followup 346 patients (39%) had biochemical recurrence. On multivariate analysis the significant predictors of biochemical recurrence were age more than 60 years, prostate specific antigen more than 10 ng/ml, Gleason score 4 + 3 and 8-10, 2 or more sites of positive surgical margins and prostate specimen weight 30 gm or less. As determined by the concordance index, the overall predictive accuracy of the model was 0.67, while it was 0.60 for the postoperative Kattan nomogram in this patient population.

Conclusions: We have developed a simple instrument that, once validated, may aid in the postoperative decision making process for men at intermediate risk for recurrence after prostatectomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Actuarial 10-year Kaplan-Meier estimates of biochemical recurrence rates in patients
See this image and copyright information in PMC

References

    1. Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term Biochemical Disease-Free and Cancer-specific Survival Following Anatomic Radical Retropubic Prostatectomy: The 15-Year Johns Hopkins Experience. Urol Clin North Am. 2001;28:555. - PubMed
    1. Roehl KA, Han M, Ramos CG, Antenor JAV, Catalona WJ. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol. 2004;172:910. - PubMed
    1. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Schnall M, Tomaszewski JE, et al. A Multivariate Analysis of Clinical and Pathological Factors that Predict for Prostate Specific Antigen Failure after Radical Prostatectomy for Prostate Cancer. J Urol. 1995;154:131. - PubMed
    1. Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D. Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer. N Engl J Med. 1999;341:1781. - PubMed
    1. Thompson IM, Jr, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, et al. Adjuvant Radiotherapy for Pathologically Advanced Prostate Cancer: A Randomized Clinical Trial. JAMA. 2006;296:2329. - PubMed

Publication types

Substances