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A closer look at extraprostatic extension (EPE): Evaluation of PSA relapse rates following prostatectomy (RP) for pT3aN0 prostate cancer with or without margin involvement.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: EPE is an established risk factor for PSA failure following RP; however, often this is identified in the context of other high-risk feature(s). The objective of the current investigation study is to describe the PSA relapse rate for patients with confirmed EPE and identify associated factors for risk stratification. Methods: Retrospective analysis of patient- and tumor-specific factors. Eligible patients underwent RP for biopsy-proven prostate adenocarcinoma and pathologic finding of EPE. Patients with PSA >30 at diagnosis, involved seminal vesicles or lymph nodes at RP, or who received adjuvant therapy (hormone or radiation) were excluded. Results: Between 2002 and 2010, 644 patients underwent RP, of whom 95 had EPE and were eligible per above. The median age at diagnosis was 64 years (range 44-74), and pre-RP PSA 6.1 (1.8-25.4). At a median PSA follow-up of 64 months (range 13.3-136.5), 38 patients had experienced PSA relapse at a median of 18 months post-RP (1.2-129.8), of whom 28 had involved surgical margins. For the entire population, PSA relapse at 5 years was 39.2% (95% CI, 38.1-40.3%). Factors associated with PSA relapse included pre- and post-RP PSA and Gleason score (GS), and margin status. Subset evaluation by RP Gleason score and margin status is demonstrated in the table. Conclusions: Within the present study, all patients with EPE appear to have elevated rates of PSA relapse within 5 years of RP. Longer follow-up is necessary to determine whether the low-risk group may be safely observed following margin-negative RP. Low-grade EPE cases with involved margin and/or higher-risk Gleason score patients with any EPE/margin involvement have high rates of early PSA relapse, and should be recommended early post-operative (adjuvant) therapy in order to optimize PSA control.
|Gleason score (at RP)||Margin||5y failure
Abstracts by John Morgan Watkins:
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Gleason <6 (G6) prostate cancer (PC) at radical prostatectomy (RP): Does a high-risk setting truly exist? A recursive partitioning analysis (RPA).Meeting: 2016 Genitourinary Cancers Symposium | Abstract No: 132
Do margin details matter? The prognostic significance of capsule invasion at the site of involved margin in prostatectomy specimens.Meeting: 2015 Genitourinary Cancers Symposium | Abstract No: 131