Patients treated with radical prostatectomy with positive digital rectal examination findings in the intermediate‑risk group are prone to PSA recurrence

Furubayashi,Nobuki; Negishi,Takahito; Ura,Shintaro; Mutaguchi,Jun; Taguchi,Kenichi; Shimokawa,Mototsugu; Nakamura,Motonobu

doi:10.3892/ol.2016.4485

Patients treated with radical prostatectomy with positive digital rectal examination findings in the intermediate‑risk group are prone to PSA recurrence

Authors:
- Nobuki Furubayashi
- Takahito Negishi
- Shintaro Ura
- Jun Mutaguchi
- Kenichi Taguchi
- Mototsugu Shimokawa
- Motonobu Nakamura
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Affiliations: Department of Urology, National Kyushu Cancer Center, Fukuoka 811‑1395, Japan, Department of Pathology, National Kyushu Cancer Center, Fukuoka 811‑1395, Japan, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka 811‑1395, Japan
Published online on: April 20, 2016 https://doi.org/10.3892/ol.2016.4485
Pages: 3882-3888

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Abstract

The present study aimed to evaluate the possibility of performing radical prostatectomy (RP) alone to achieve a radical cure for prostate cancer in the intermediate‑risk group. Samples were collected from 638 Japanese patients who underwent antegrade RP between August 1998 and May 2013; subsequently, 157 patients were excluded. According to the D'Amico criteria, the low‑, intermediate‑ and high‑risk groups comprised 107, 222 and 152 patients, respectively. The 5‑year prostate‑specific antigen (PSA) failure‑free survival rates in the low‑, intermediate‑, and high‑risk groups were 96.5, 88.9 and 72.6%, respectively (P<0.001; degrees of freedom=2). In the intermediate‑risk group, the difference in PSA failure‑free survival between the 0<PSA≤10 and 10<PSA≤20 ng/ml, and the biopsy Gleason score 6 and 7 groups were not statistically significant, according to the log‑rank test (P=0.2266 and P=0.1329, respectively). However, the difference in PSA failure‑free survival between the clinical tumor stage (cT)1c and cT2a/b groups was statistically significant based on the log‑rank test (P<0.0001). The results of the multivariate analysis revealed that, of the preoperative characteristics, only the cT was a significant predictor in patients with and without PSA failure (P<0.001). Therefore, patients classified into the intermediate‑risk group with cT2a/b stage, according to positive digital rectal examination findings, and are not considered to be likely to achieve a complete cure with RP surgery alone. In summary, for patients meeting these criteria in the intermediate‑risk group, RP surgery alone is likely to be insufficient, and other additional treatments may be considered subsequent to RP.

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1	Cooperberg MR, Broering JM and Carroll PR: Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 28:1117–1123. 2010. View Article : Google Scholar : PubMed/NCBI
2	Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, et al: Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group: Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 367:203–213. 2012. View Article : Google Scholar : PubMed/NCBI
3	Rifkin MD: MRI of the prostate. Crit Rev Diagn Imaging. 31:223–262. 1990.PubMed/NCBI
4	Tempany CM, Zhou X, Zerhouni EA, Rifkin MD, Quint LE, Piccoli CW, Ellis JH and McNeil BJ: Staging of prostate cancer: Results of Radiology Diagnostic Oncology Group project comparison of three MR imaging techniques. Radiology. 192:47–54. 1994. View Article : Google Scholar : PubMed/NCBI
5	Wolf JS Jr, Cher M, Dall'era M, Presti JC J, Hricak H and Carroll PR: The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol. 153:993–999. 1995. View Article : Google Scholar : PubMed/NCBI
6	Oesterling JE, Jacobsen SJ, Klee GG, Pettersson K, Piironen T, Abrahamsson PA, Stenman UH, Dowell B, Lövgren T and Lilja H: Free, complexed and total serum prostate specific antigen: The establishment of appropriate reference ranges for their concentrations and ratios. J Urol. 154:1090–1095. 1995. View Article : Google Scholar : PubMed/NCBI
7	Epstein JI, Allsbrook WC Jr, Amin MB and Egevad LL: ISUP Grading Committee: The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol. 29:1228–1242. 2005. View Article : Google Scholar : PubMed/NCBI
8	D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ and Wein A: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 280:969–974. 1998. View Article : Google Scholar : PubMed/NCBI
9	Smith JA Jr: Radical prostatectomy for low risk carcinoma of the prostate. World J Urol. 26:443–446. 2008. View Article : Google Scholar : PubMed/NCBI
10	Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff RO, Storme G, Bernier J, Kuten A, Sternberg C, et al: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet. 360:103–106. 2002. View Article : Google Scholar : PubMed/NCBI
11	D'Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A and Kantoff PW: 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA. 292:821–827. 2004. View Article : Google Scholar : PubMed/NCBI
12	Pierorazio PM, Ross AE, Lin BM, Epstein JI, Han M, Walsh PC, Partin AW, Pavlovich CP and Schaeffer EM: Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy. BJU Int. 110:1122–1128. 2012. View Article : Google Scholar : PubMed/NCBI
13	Epstein JI, Allsbrook WC Jr, Amin MB and Egevad LL: ISUP Grading Committee: The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol. 29:1228–1242. 2005. View Article : Google Scholar : PubMed/NCBI
14	Sobin LH, Gospodarowicz MK and Wittekind Ch: Urological Tumors. TNM Classification of Malignant Tumors (7th). Wiley-Blackwell. (Oxford). 243–248. 2009.
15	The Japanese Urological Association (eds): Surgical Therapy. In: Clinical Practice Guidelines for Prostate Cancer in Japan. 2012 version. Kanehara-shuppan Press. (Tokyo). 115–117. 2012.
16	Roehl KA, Han M, Ramos CG, Antenor JA and Catalona WJ: Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: Long-term results. J Urol. 172:910–914. 2004. View Article : Google Scholar : PubMed/NCBI
17	Porter CR, Kodama K, Gibbons RP, Correa R Jr, Chun FK, Perrotte P and Karakiewicz PI: 25-year prostate cancer control and survival outcomes: A 40-year radical prostatectomy single institution series. J Urol. 176:569–574. 2006. View Article : Google Scholar : PubMed/NCBI
18	Isbarn H, Wanner M, Salomon G, Steuber T, Schlomm T, Köllermann J, Sauter G, Haese A, Heinzer H, Huland H and Graefen M: Long-term data on the survival of patients with prostate cancer treated with radical prostatectomy in the prostate-specific antigen era. BJU Int. 106:37–43. 2010. View Article : Google Scholar : PubMed/NCBI
19	Suardi N, Porter CR, Reuther AM, Walz J, Kodama K, Gibbons RP, Correa R, Montorsi F, Graefen M, Huland H, et al: A nomogram predicting long-term biochemical recurrence after radical prostatectomy. Cancer. 112:1254–1263. 2008. View Article : Google Scholar : PubMed/NCBI
20	Carver BS, Bianco FJ Jr, Scardino PT and Eastham JA: Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer. J Urol. 176:564–568. 2006. View Article : Google Scholar : PubMed/NCBI
21	Gontero P, Marchioro G, Pisani R, Zaramella S, Sogni F, Kocjancic E, Mondaini N, Bonvini D, Tizzani A and Frea B: Is radical prostatectomy feasible in all cases of locally advanced non-bone metastatic prostate cancer? Results of a single-institution study. Eur Urol. 51:922–929. 2007. View Article : Google Scholar : PubMed/NCBI
22	Van Poppel H and Joniau S: An analysis of radical prostatectomy in advanced stage and high-grade prostate cancer. Eur Urol. 53:253–259. 2008. View Article : Google Scholar : PubMed/NCBI
23	Miocinovic R, Berglund RK, Stephenson AJ, Jones JS, Fergany A, Kaouk J and Klein EA: Avoiding androgen deprivation therapy in men with high-risk prostate cancer: The role of radical prostatectomy as initial treatment. Urology. 77:946–950. 2011. View Article : Google Scholar : PubMed/NCBI
24	Catalona WJ, Smith DS and Ornstein DK: Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/ml and benign prostate examination. Enhancement of specificity with free PSA measurements. JAMA. 277:1452–1455. 1997. View Article : Google Scholar : PubMed/NCBI
25	Rietbergen JB, Hoedemaeker RF, Kruger AE, Kirkels WJ and Schröder FH: The changing pattern of prostate cancer at the time of diagnosis: Characteristics of screen detected prostate cancer in a population based screening study. J Urol. 161:1192–1198. 1999. View Article : Google Scholar : PubMed/NCBI
26	Gleason DF and Mellinger GT: Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 111:58–64. 1974.PubMed/NCBI
27	McNeal JE, Villers AA, Redwine EA, Freiha FS and Stamey TA: Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate. Cancer. 66:1225–1233. 1990. View Article : Google Scholar : PubMed/NCBI
28	Epstein JI, Pizov G and Walsh PC: Correlation of pathologic findings with progression after radical retropubic prostatectomy. Cancer. 71:3582–3593. 1993. View Article : Google Scholar : PubMed/NCBI
29	Chan TY, Partin AW, Walsh PC and Epstein JI: Prognostic significance of Gleason score 3+4 versus Gleason score 4+3 tumor at radical prostatectomy. Urology. 56:823–827. 2000. View Article : Google Scholar : PubMed/NCBI
30	Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA and Ramchandani P: Prostate cancer tumor markers. Campbell-Walsh urology tenth edition review. McDougal SW: (10th). Elsevier Saunders. (Philadelphia, PA). 2748–2770. 2011.
31	Gosselaar C, Roobol MJ, Roemeling S and Schröder FH: The role of the digital rectal examination in subsequent screening visits in the European randomized study of screening for prostate cancer (ERSPC), Rotterdam. Eur Urol. 54:581–588. 2008. View Article : Google Scholar : PubMed/NCBI
32	Borden LS Jr, Wright JL, Kim J, Latchamsetty K and Porter CR: An abnormal digital rectal examination is an independent predictor of Gleason > or =7 prostate cancer in men undergoing initial prostate biopsy: A prospective study of 790 men. BJU Int. 99:559–563. 2007. View Article : Google Scholar : PubMed/NCBI
33	Okotie OT, Roehl KA, Han M, Loeb S, Gashti SN and Catalona WJ: Characteristics of prostate cancer detected by digital rectal examination only. Urology. 70:1117–1120. 2007. View Article : Google Scholar : PubMed/NCBI
34	Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, Feng Z, Parnes HL and Coltman CA Jr: Assessing prostate cancer risk: Results from the prostate cancer prevention trial. J Natl Cancer Inst. 98:529–534. 2006. View Article : Google Scholar : PubMed/NCBI