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01-08-2017 | Original Article

Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy

Authors: Jean Baptiste Beauval, Guillaume Ploussard, Bastien Cabarrou, Mathieu Roumiguié, Adil Ouzzane, Jérome Gas, Annabelle Goujon, Gautier Marcq, Romain Mathieu, Sébastien Vincendeau, Xavier Cathelineau, Pierre Mongiat-Artus, Laurent Salomon, Michel Soulié, Arnaud Méjean, Alexandre de La Taille, Morgan Rouprêt, François Rozet, Committee of Cancerology of the Association of French Urology

Published in: World Journal of Urology | Issue 8/2017

Abstract

Background

Prognoses for intermediate-risk prostate cancer (PCa) remain heterogeneous. Improved substratification could optimize treatment and monitoring strategies. The objective was to validate this subclassification in a radical prostatectomy (RP) series.

Methods

Between 2000 and 2011, 4038 patients who underwent RP for intermediate-risk PCa in seven French academic centers were included. Unfavorable intermediate-risk (UIR) PCa was defined as having a primary Gleason score of 4, ≥50% positive biopsy cores (PPBC), or more than one D’Amico intermediate-risk factor (i.e., cT2b, PSA 10–20, or Gleason score 7). Remaining PCa cases were classified as favorable. Main endpoints were pathologic results (pT stage, final Gleason score, surgical margin status), and oncologic outcomes were assessed according to PSA recurrence-free survival (PSA-RFS). Univariate and multivariate analyses were performed using the log-rank test and the Cox proportional hazards model.

Results

Median follow-up was 48 months (95% CI = [45–49]). Patients with UIR had worse PSA-RFS (68.17 vs. 81.98% at 4 years, HR = 1.97, 95% CI = [1.71; 2.27], p < 0.0001) compared to those with a favorable disease. The need for adjuvant therapy was significantly greater for UIR patients (43.5 vs. 29.2%, p < 0.0001). In multivariate analysis, primary Gleason score of 4 (HR = 1.81, 95% CI = [1.55; 2.12], p < 0.0001) and PPBC ≥ 50% (HR = 1.26, 95% CI = [1.02; 1.56], p = 0.0286) were significant preoperative predictors for worse PSA-RFS.

Conclusions

This study highlights the heterogeneity of NCCN intermediate-risk patients and validates (in a large RP cohort) the previously proposed subclassification for this group. This classification can significantly predict both pathologic and oncologic outcomes. This easy-to-use stratification could help physicians’ decision making. Prospective study and new tools as genomic tests and novel molecular-based approaches can improve this stratification in the future for patient counseling.

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Title: Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy
Authors: Jean Baptiste Beauval
Guillaume Ploussard
Bastien Cabarrou
Mathieu Roumiguié
Adil Ouzzane
Jérome Gas
Annabelle Goujon
Gautier Marcq
Romain Mathieu
Sébastien Vincendeau
Xavier Cathelineau
Pierre Mongiat-Artus
Laurent Salomon
Michel Soulié
Arnaud Méjean
Alexandre de La Taille
Morgan Rouprêt
François Rozet
Committee of Cancerology of the Association of French Urology
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 8/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1979-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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