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Japanese Journal of Clinical Oncology Advance Access originally published online on April 24, 2009
Japanese Journal of Clinical Oncology 2009 39(6):387-393; doi:10.1093/jjco/hyp032
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© The Author (2009). Published by Oxford University Press. All rights reserved

Risk Stratification of High-grade Prostate Cancer Treated with Antegrade Radical Prostatectomy with Intended Wide Resection

Shinya Yamamoto1, Satoru Kawakami1, Junji Yonese1, Yasuhisa Fujii1, Tetsuro Tsukamoto1, Yuhei Ohkubo1, Yoshinobu Komai1, Yuichi Ishikawa2 and Iwao Fukui1

1 Department of Urology, Japanese Foundation for Cancer Research, Cancer Institute Hospital
2 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan

For reprints and all correspondence: Shinya Yamamoto, Department of Urology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo 135-8550, Japan. E-mail: shinya.yamamoto{at}jfcr.or.jp

Received January 4, 2009; accepted March 5, 2009

Objective: The aim of this study was to assess the surgical outcome of high-grade prostate cancer (PCA) treated with antegrade radical prostatectomy with intended wide resection (aRP) and to establish the risk stratification.

Methods: A consecutive 77 Japanese patients with Gleason score 8–10 PCA were treated with aRP alone and excluding patients with persistently elevated prostate-specific antigen (PSA), prospectively observed without any treatment until PSA failure was confirmed. PSA failure-free, cancer-specific and overall survival curves were generated with Kaplan–Meier method and the difference between groups was assessed with log-rank test. Cox's proportional hazards model was used to elucidate predictors of PSA failure.

Results: During a median follow-up of 6 years, PSA failure was observed in 41 (53%) of the 77 patients. Five- and 10-year PSA failure-free survival rates of the entire cohort were 44.6% and 40.1%, respectively. Both overall and cancer-specific survival rates of the entire cohort at 5 and 10 years were 96.8% and 87.9%, respectively. In a multivariate analysis, PSA (P = 0.008), specimen confinement (SC) (P = 0.006) and persistently elevated PSA after aRP were identified as significant and independent predictors of PSA failure. When stratifying patients into three risk groups according to PSA level and SC status, PSA failure-free survival rate in patients with PSA < 10 ng/ml and specimen-confined disease (SCD) was significantly better than that in those of any other groups.

Conclusions: Good prognosis can be expected in patients with high-grade PCA treated with aRP alone when PSA < 10 ng/ml and the tumor was removed as an SCD.

Key Words: antegrade radical prostatectomy • high-grade prostate cancer • prostate-specific antigen • specimen-confined disease


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