Top

Published in:

01-04-2014 | Topic Paper

Oncologic outcomes after minimally invasive radical prostatectomy in patients with seminal vesicle invasion (pT3b) without adjuvant therapy

Authors: Aurélien Forgues, François Rozet, François Audenet, Adil Ouzzane, Rafaël Sanchez-Salas, Eric Barret, Marc Galiano, Dominique Prapotnich, Xavier Cathelineau

Published in: World Journal of Urology | Issue 2/2014

Abstract

Purpose

To evaluate the long-term outcomes of patients with prostate cancer who have pathological pT3b N0–Nx, with postoperative PSA < 0.1 ng/ml and no systematic adjuvant treatment.

Materials and methods

Using a monocentric prospectively maintained database, we identified among 2,142 men who underwent minimally invasive radical prostatectomy, 104 pT3b N0–Nx patients, with postoperative PSA < 0.1 ng/ml and at least 5 years of follow-up. Patients were considered for salvage treatment at biochemical recurrence (PSA ≥ 0.2 ng/ml).

Results

The median time of follow-up was 83.5 months (interquartile range [IQR]: 69–99). Overall, 102 patients (98 %) had T2 clinical stage or less. Specimen Gleason score was 7 in 71 patients (68 %) and <7 in 15 (14 %). Thirty-eight patients (37 %) were upgraded for Gleason score after radical prostatectomy. The overall 5-year probability of freedom from biochemical recurrence for the entire cohort was 55.8 % (95 % CI 45.8–65.8) and 73.3 % for patients who had specimen Gleason score <7 (p = 0.005). In univariate analysis, specimen Gleason score and surgical margin status were significant predictors for biochemical failure after radical prostatectomy (p = 0.05 and 0.007, respectively). In multivariate analysis, only specimen Gleason score >7 was significantly associated with biochemical failure (p = 0.009).

Conclusion

SVI is an adverse prognostic factor, but it is not associated with a uniformly poor prognosis. Specimen Gleason score and surgical margin status are significant predictors of recurrence after radical prostatectomy in patients with prostate cancer and SVI.

Siddiqui SA, Boorjian SA, Blute ML, Rangel LJ, Bergstralh EJ, Karnes RJ et al (2011) Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer. BJU Int 107:383–388. doi:10.1111/j.1464-410X.2010.09565.x PubMedCrossRef

Valicenti RK, Gomella LG, Ismail M, Strup SE, Mulholland SG, Dicker AP et al (1999) The efficacy of early adjuvant radiation therapy for pT3N0 prostate cancer: a matched-pair analysis. Int J Radiat Oncol Biol Phys 45:53–58PubMedCrossRef

Lee HM, Solan MJ, Lupinacci P, Gomella LG, Valicenti RK (2004) Long-term outcome of patients with prostate cancer and pathologic seminal vesicle invasion (pT3b): effect of adjuvant radiotherapy. Urology 64:84–89. doi:10.1016/j.urology.2004.02.004 PubMedCrossRef

Catton C, Gospodarowicz M, Warde P, Panzarella T, Catton P, McLean M et al (2001) Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 59:51–60PubMedCrossRef

D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Schnall M, Tomaszewski JE et al (1995) A multivariate analysis of clinical and pathological factors that predict for prostate specific antigen failure after radical prostatectomy for prostate cancer. J Urol 154:131–138PubMedCrossRef

Stephenson AJ, Kattan MW, Eastham JA, Bianco FJ Jr, Yossepowitch O, Vickers AJ et al (2009) Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol 27:4300–4305. doi:10.1200/JCO.2008.18.2501 PubMedCentralPubMedCrossRef

Secin FP, Bianco FJ Jr, Vickers AJ, Reuter V, Wheeler T, Fearn PA et al (2006) Cancer-specific survival and predictors of prostate-specific antigen recurrence and survival in patients with seminal vesicle invasion after radical prostatectomy. Cancer 106:2369–2375. doi:10.1002/cncr.21895 PubMedCrossRef

Blute ML, Bergstralh EJ, Iocca A, Scherer B, Zincke H (2001) Use of Gleason score, prostate specific antigen, seminal vesicle and margin status to predict biochemical failure after radical prostatectomy. J Urol 165:119–125. doi:10.1097/00005392-200101000-00030 PubMedCrossRef

Epstein JI, Partin AW, Potter SR, Walsh PC (2000) Adenocarcinoma of the prostate invading the seminal vesicle: prognostic stratification based on pathologic parameters. Urology 56:283–288PubMedCrossRef

10.

Bastide C, Rossi D, Lechevallier E, Bladou F, Barriol D, Bretheau D, et al (2012) Seminal vesicle invasion: what is the best adjuvant treatment after radical prostatectomy? BJU Int 109:525–530; discussion 531–522. doi:10.1111/j.1464-410X.2011.10332.x

11.

Bloom KD, Richie JP, Schultz D, Renshaw A, Saegaert T, D’Amico AV (2004) Invasion of seminal vesicles by adenocarcinoma of the prostate: PSA outcome determined by preoperative and postoperative factors. Urology 63:333–336. doi:10.1016/j.urology.2003.09.042 PubMedCrossRef

12.

Billis A, Teixeira DA, Stelini RF, Quintal MM, Guimaraes MS, Ferreira U (2007) Seminal vesicle invasion in radical prostatectomies: which is the most common route of invasion? Int Urol Nephrol 39:1097–1102. doi:10.1007/s11255-007-9189-7 PubMedCrossRef

13.

Pierorazio PM, Ross AE, Schaeffer EM, Epstein JI, Han M, Walsh PC et al (2011) A contemporary analysis of outcomes of adenocarcinoma of the prostate with seminal vesicle invasion (pT3b) after radical prostatectomy. J Urol 185:1691–1697. doi:10.1016/j.juro.2010.12.059 PubMedCrossRef

14.

Salomon L, Anastasiadis AG, Johnson CW, McKiernan JM, Goluboff ET, Abbou CC et al (2003) Seminal vesicle involvement after radical prostatectomy: predicting risk factors for progression. Urology 62:304–309PubMedCrossRef

15.

Budaus L, Isbarn H, Eichelberg C, Lughezzani G, Sun M, Perrotte P et al (2010) Biochemical recurrence after radical prostatectomy: multiplicative interaction between surgical margin status and pathological stage. J Urol 184:1341–1346. doi:10.1016/j.juro.2010.06.018 PubMedCrossRef

16.

Spahn M, Briganti A, Capitanio U, Kneitz B, Gontero P, Karnes JR et al (2012) Outcome predictors of radical prostatectomy followed by adjuvant androgen deprivation in patients with clinical high risk prostate cancer and pT3 surgical margin positive disease. J Urol 188:84–90. doi:10.1016/j.juro.2012.02.2572 PubMedCrossRef

17.

Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V et al (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71. doi:10.1016/j.eururo.2010.10.039 PubMedCrossRef

18.

Melia J, Moseley R, Ball RY, Griffiths DF, Grigor K, Harnden P et al (2006) A UK-based investigation of inter- and intra-observer reproducibility of Gleason grading of prostatic biopsies. Histopathology 48:644–654. doi:10.1111/j.1365-2559.2006.02393.x PubMedCrossRef

19.

Brajtbord JS, Lavery HJ, Nabizada-Pace F, Senaratne P, Samadi DB (2011) Endorectal magnetic resonance imaging has limited clinical ability to preoperatively predict pT3 prostate cancer. BJU Int 107:1419–1424. doi:10.1111/j.1464-410X.2010.09599.x PubMedCrossRef

20.

Renard-Penna R, Roupret M, Comperat E, Ayed A, Coudert M, Mozer P, et al (2011) Accuracy of high resolution (1.5 tesla) pelvic phased array magnetic resonance imaging (MRI) in staging prostate cancer in candidates for radical prostatectomy: results from a prospective study. Urol Oncol. doi:10.1016/j.urolonc.2011.02.017

21.

Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L et al (2005) Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 366:572–578. doi:10.1016/S0140-6736(05)67101-2 PubMedCrossRef

22.

Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Storkel S et al (2009) Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 27:2924–2930. doi:10.1200/JCO.2008.18.9563 PubMedCrossRef

23.

Eggener SE, Roehl KA, Smith ND, Antenor JA, Han M, Catalona WJ (2005) Contemporary survival results and the role of radiation therapy in patients with node negative seminal vesicle invasion following radical prostatectomy. J Urol 173:1150–1155. doi:10.1097/01.ju.0000155158.79489.48 PubMedCrossRef

24.

Dorff TB, Flaig TW, Tangen CM, Hussain MH, Swanson GP, Wood DP Jr et al (2011) Adjuvant androgen deprivation for high-risk prostate cancer after radical prostatectomy: SWOG S9921 study. J Clin Oncol 29:2040–2045. doi:10.1200/JCO.2010.32.2776 PubMedCentralPubMedCrossRef

25.

Wirth MP, Weissbach L, Marx FJ, Heckl W, Jellinghaus W, Riedmiller H, et al (2004) Prospective randomized trial comparing flutamide as adjuvant treatment versus observation after radical prostatectomy for locally advanced, lymph node-negative prostate cancer. Eur Urol 45:267–270; discussion 270 doi:10.1016/j.eururo.2003.10.013

26.

McLeod DG, Iversen P, See WA, Morris T, Armstrong J, Wirth MP (2006) Bicalutamide 150 mg plus standard care vs standard care alone for early prostate cancer. BJU Int 97:247–254. doi:10.1111/j.1464-410X.2005.06051.x PubMedCrossRef

Title: Oncologic outcomes after minimally invasive radical prostatectomy in patients with seminal vesicle invasion (pT3b) without adjuvant therapy
Authors: Aurélien Forgues
François Rozet
François Audenet
Adil Ouzzane
Rafaël Sanchez-Salas
Eric Barret
Marc Galiano
Dominique Prapotnich
Xavier Cathelineau
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 2/2014
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-013-1133-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oncologic outcomes after minimally invasive radical prostatectomy in patients with seminal vesicle invasion (pT3b) without adjuvant therapy

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2014

Impact of international variation of prostate cancer on a predictive nomogram for biochemical recurrence in clinically localised prostate cancer

The impact of obesity on the predictive accuracy of PSA in men undergoing prostate biopsy

The impact of smoking on pathologic response to neoadjuvant cisplatin-based chemotherapy in patients with muscle-invasive bladder cancer

The method of GFR determination impacts the estimation of cisplatin eligibility in patients with advanced urothelial cancer

Visceral obesity predicts adverse pathological features in urothelial bladder cancer patients undergoing radical cystectomy: a retrospective cohort study

Urodynamic characterization of lower urinary tract symptoms in men less than 40 years of age