The risk of biochemical recurrence for intermediate-risk prostate cancer after radical prostatectomy

Abstract

Objectives: To report oncological outcomes including biochemical recurrence (BR) following radical prostatectomy (RP) from a large consecutive cohort operated in an 18-year period. Additionally, an in-depth analysis of outcomes among D'Amico intermediate-risk patients is presented.

Materials and methods: A total of 2,091 patients with PCa who underwent RP at Department of Urology, Rigshospitalet, Copenhagen, Denmark between 1995 and 2013 were included. Univariate and multiple cause-specific Cox regression analyses for BR were applied using competing risk models. Death prior to BR was considered a competing event. BR was defined as the first PSA ≥0.2 ng/ml. No patient received adjuvant therapy prior to BR.

Results: Overall, the 5- and 10-years cumulative incidence of BR was 21.9% and 32.0%. The 10-year cumulative incidence of BR was 17.9%, 31.9% and 47.9% for D'Amico low-, intermediate- and high-risk patients, respectively. Among intermediate-risk patients, the 10-year cumulative incidence of BR was 24.0%, 39.9%, and 47.9% for patients harboring one, two or three risk factors, respectively (Gray test: p < 0.0001). In multivariate analysis, PSA, RP GS, pT category, and positive surgical margins were significantly associated with an increased risk of BR.

Conclusions: The risk of BR among patients with intermediate-risk disease is not uniform and is highly dependent on the number of risk factors per patient. Intermediate-risk patients have a comparable risk of recurrence as high-risk patients, and this should be taken into consideration when counseling patients prior to RP.

Keywords: D’Amico; Radical prostatectomy; biochemical recurrence; competing-risk; intermediate-risk.