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Multicenter Study
. 2014 Jun 14:14:49.
doi: 10.1186/1471-2490-14-49.

Disease-specific outcomes of radical prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time

Sigve Andersen  1 , Elin Richardsen, Yngve Nordby, Nora Ness, Oystein Størkersen, Khalid Al-Shibli, Tom Donnem, Helena Bertilsson, Lill-Tove Busund, Anders Angelsen, Roy M Bremnes
Affiliations
Multicenter Study

Disease-specific outcomes of radical prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time

Sigve Andersen et al. BMC Urol. .

Abstract

Background: Prostate cancer is the most common male malignancy and a mayor cause of mortality in the western world. The impact of clinicopathological variables on disease related outcomes have mainly been reported from a few large US series, most of them not reporting on perineural infiltration. We therefore wanted to investigate relevant cancer outcomes in patients undergoing radical prostatectomy in two Norwegian health regions with an emphasis on the impact of perineural infiltration (PNI) and prostate specific antigen- doubling time (PSA-DT).

Methods: We conducted a retrospective analysis of 535 prostatectomy patients at three hospitals between 1995 and 2005 estimating biochemical failure- (BFFS), clinical failure- (CFFS) and prostate cancer death-free survival (PCDFS) with the Kaplan-Meier method. We investigated clinicopathological factors influencing risk of events using cox proportional hazard regression.

Results: After a median follow-up of 89 months, 170 patients (32%) experienced biochemical failure (BF), 36 (7%) experienced clinical failure and 15 (3%) had died of prostate cancer. pT-Stage (p = 0.001), preoperative PSA (p = 0.047), Gleason Score (p = 0.032), non-apical positive surgical margins (PSM) (p = 0.003) and apical PSM (p = 0.031) were all independently associated to BFFS. Gleason score (p = 0.019), PNI (p = 0.012) and non-apical PSM (p = 0.002) were all independently associated to CFFS while only PNI (P = 0.047) and subgroups of Gleason score were independently associated to PCDFS. After BF, patients with a shorter PSA-DT had independent and significant worse event-free survivals than patients with PSA-DT > 15 months (PSA-DT = 3-9 months, CFFS HR = 6.44, p < 0.001, PCDFS HR = 13.7, p = 0.020; PSA-DT < 3 months, CFFS HR = 11.2, p < 0.001, PCDFS HR = 27.5, p = 0.006).

Conclusions: After prostatectomy, CFFS and PCDFS are variable, but both are strongly associated to Gleason score and PNI. In patients with BF, PSA-DT was most strongly associated to CF and PCD. Our study adds weight to the importance of PSA-DT and re-launches PNI as a strong prognosticator for clinically relevant endpoints.

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Figures

Figure 1
Figure 1
Overlapping Kaplan-Meier curves, each illustrating event-free survival for the whole cohort for the specific event. Note that the Y-axis has been modified with a proportion of 0.5 as the origin to better illustrate the differences. PCDF-survival = Prostate cancer death free-survival; CFF-survival = Clinical failure free-survival; BFF = Biochemical failure free-survival.
Figure 2
Figure 2
Kaplan-Meier curves of patients experiencing biochemical failure for (A) Clinical failure free-survival stratified by PSA-doubling time categories and (B) Prostate cancer death free-survival stratified by PSA-doubling time. See Table 3 for details regarding hazard levels and level of significance.
See this image and copyright information in PMC

References

    1. Cancer registery of Norway. Cancer in Norway 2010 - cancer incidence, mortality, survival and prevalence in Norway. Oslo: Cancer registery of Norway; 2012. Ref Type: Report. http://www.kreftregisteret.no.
    1. Kvale R, Skarre E, Tonne A, Kyrdalen AE, Norstein J, Angelsen A, Wahlqvist R, Fossa SD. Curative treatment of prostatic cancer in Norway in 1998 and 2001. Tidsskr Nor Laegeforen. 2006;126(7):912–916. - PubMed
    1. Center MM, Jemal A, Lortet-Tieulent J, Ward E, Ferlay J, Brawley O, Bray F. International variation in prostate cancer incidence and mortality rates. Eur Urol. 2012;61(6):1079–1092. doi: 10.1016/j.eururo.2012.02.054. - DOI - PubMed
    1. Kvale R, Moller B, Angelsen A, Dahl O, Fossa SD, Halvorsen OJ, Hoem L, Solberg A, Wahlqvist R, Bray F. Regional trends in prostate cancer incidence, treatment with curative intent and mortality in Norway 1980–2007. Cancer Epidemiol. 2010;34(4):359–367. doi: 10.1016/j.canep.2010.04.017. - DOI - PubMed
    1. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, Nsouli I, Iyer P, Cartagena R, Snider G, Roehrborn C, Sharifi R, Blank W, Pandya P, Andriole GL, Culkin D, Wheeler T. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203–213. doi: 10.1056/NEJMoa1113162. - DOI - PMC - PubMed

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