Presentation Authors: Sophie Knipper*, Hamburg, Germany, Pierre Karakiewicz, Montréal, Canada, Thomas Steuber, Markus Graefen, Derya Tilki, Hamburg, Germany
Introduction: Several definitions of high-risk prostate cancer (PCa) exist. We examined the impact of different pre-treatment definitions on metastasis-free survival (MFS), cancer-specific mortality (CSM) and overall mortality (OM) after radical prostatectomy (RP).
Methods: For this, 27,996 patients with clinically localized disease who underwent RP at a single institution between 1992 and 2018 were retrospectively analysed. Six pre-treatment definitions of high-risk PCa (prostate-specific antigen [PSA] â‰¥20 ng/ml, biopsy Gleason score [GS] 8- 10, clinical stage â‰¥T2c, clinical stage T3 [cT3], D&[prime]Amico definition, National Comprehensive Cancer Network [NCCN] definition) were evaluated. Kaplan-Meier as well as multivariable Cox regression analyses were used to compare outcomes between the groups.
Results: Depending on the definition, patients with high-risk PCa comprised between 0.9% (when using cT3 as the criterion) and 20.4% (when using the D&[prime]Amico criterion) of the population. Median follow-up was 60.9 months. 10-year metastasis-free survival rates ranged from 78.9% (PSA ≥20 ng/ml) to 66.5% (Gleason 8-10). 10-year cancer-specific survival rates varied from 94.6 (PSA â‰¥20 ng/ml) to 86.6% (cT3). 10-year overall survival rates ranged from 87.1 (NCCN high risk) to 79.3% (â‰¥cT2c). On multivariable analysis, all high-risk definitions were associated with a higher risk of metastasis compared to lower risk groups (hazard ratio [HR] between 3.3 for â‰¥cT2c and 9.5 for Gleason 8-10; all p < 0.001). All high-risk definitions were associated with a higher risk of CSM compared to lower risk groups (HR between 3.4 for PSA â‰¥20 ng/ml and 6.4 for cT3; all p < 0.001). All definitions of high risk were associated with a higher risk of OM (HR between 2.0 for PSA â‰¥20 ng/ml to 2.4 for â‰¥cT2c; all p < 0.01).
Conclusions: Variety in outcomes exist, depending on the pre-treatment definition of high-risk PC. Among the tested, Gleason 8-10 was the strongest predictor for higher risk of metastasis, cT3 was the strongest predictor for higher risk of CSM and OM.