Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

Risk factors for prostate-specific antigen persistence in pT3aN0 prostate cancer after robot-assisted laparoscopic radical prostatectomy: a retrospective study

  • Jun Seop Kim (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jae Hoon Chung (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wan Song (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Minyong Kang (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyun Hwan Sung (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hwang Gyun Jeon (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Byong Change Jeong (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seong Il Seo (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyun Moo Lee (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seong Soo Jeon (Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2023.03.05
  • Accepted : 2023.05.05
  • Published : 2023.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The aim of this study was to evaluate the risk factors for prostate-specific antigen (PSA) persistence in pathological stage T3aN0 prostate cancer (PCa) after robot-assisted laparoscopic radical prostatectomy (RALP). Methods: A retrospective study was performed on 326 patients with pT3aN0 PCa who underwent RALP between March 2020 and February 2022. PSA persistence was defined as nadir PSA of >0.1 ng/mL after RALP, and the risk factors for PSA persistence were evaluated using logistic regression analysis. Results: Among 326 patients, 61 (18.71%) had PSA persistence and 265 (81.29%) had PSA of <0.1 ng/mL after RALP (successful radical prostatectomy [RP] group). In the PSA persistence group, 51 patients (83.61%) received adjuvant treatment. Biochemical recurrence occurred in 27 patients (10.19%) in the successful RP group during the mean follow-up period of 15.22 months. Multivariate analysis showed that the risk factors for PSA persistence were large prostate volume (hazard ratio [HR], 1.017; 95% confidence interval [CI], 1.002-1.036; p=0.046), lymphovascular invasion (LVI) (HR, 2.605; 95% CI, 1.022-6.643; p=0.045), and surgical margin involvement (HR, 2.220; 95% CI, 1.110-4.438; p=0.024). Conclusion: Adjuvant treatment may be needed for improved prognosis in patients with pT3aN0 PCa after RALP with a large prostate size, LVI, or surgical margin involvement.

Keywords

References

  1. Rakauskas A, Tawadros T, Lucca I, Herrera F, Bourhis J, Burruni R, et al. Active surveillance in males with low- to intermediate-risk localized prostate cancer: a modern prospective cohort study. Investig Clin Urol 2021;62:416-22. https://doi.org/10.4111/icu.20200601
  2. Klotz L. Active surveillance in intermediate-risk prostate cancer. BJU Int 2020;125:346-54. https://doi.org/10.1111/bju.14935
  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:7-30. https://doi.org/10.3322/caac.21590
  4. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2017;71:618-29. https://doi.org/10.1016/j.eururo.2016.08.003
  5. Jang TL, Patel N, Faiena I, Radadia KD, Moore DF, Elsamra SE, et al. Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer. Cancer 2018;124:4010-22. https://doi.org/10.1002/cncr.31726
  6. van den Ouden D, Hop WC, Schroder FH. Progression in and survival of patients with locally advanced prostate cancer (T3) treated with radical prostatectomy as monotherapy. J Urol 1998;160:1392-7. https://doi.org/10.1016/S0022-5347(01)62546-1
  7. Gozen AS, Akin Y, Ates M, Hruza M, Rassweiler J. Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer: experience of a single centre with long-term follow-up. BJU Int 2015;116:102-8. https://doi.org/10.1111/bju.12710
  8. Koo KC, Cho JS, Bang WJ, Lee SH, Cho SY, Kim SI, et al. Cancer-specific mortality among Korean men with localized or locally advanced prostate cancer treated with radical prostatectomy versus radiotherapy: a multi-center study using propensity scoring and competing risk regression analyses. Cancer Res Treat 2018;50:129-37. https://doi.org/10.4143/crt.2017.004
  9. Moris L, Cumberbatch MG, Van den Broeck T, Gandaglia G, Fossati N, Kelly B, et al. Benefits and risks of primary treatments for high-risk localized and locally advanced prostate cancer: an international multidisciplinary systematic review. Eur Urol 2020;77:614-27. https://doi.org/10.1016/j.eururo.2020.01.033
  10. Kliment J Jr, Elias B, Baluchova K, Kliment J Sr. The long-term outcomes of radical prostatectomy for very high-risk prostate cancer pT3b-T4 N0-1 on definitive histopathology. Cent European J Urol 2017;70:13-9.
  11. Casey JT, Meeks JJ, Greco KA, Wu SD, Nadler RB. Outcomes of locally advanced (T3 or greater) prostate cancer in men undergoing robot-assisted laparoscopic prostatectomy. J Endourol 2009;23:1519-22. https://doi.org/10.1089/end.2009.0388
  12. Hajili T, Ohlmann CH, Linxweiler J, Niklas C, Janssen M, Siemer S, et al. Radical prostatectomy in T4 prostate cancer after inductive androgen deprivation: results of a single-institution series with long-term follow-up. BJU Int 2019;123:58-64. https://doi.org/10.1111/bju.14393
  13. Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, et al. Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med 2017;376:417-28. https://doi.org/10.1056/NEJMoa1607529
  14. Wiegel T, Bartkowiak D, Bottke D, Thamm R, Hinke A, Stockle M, et al. Prostate-specific antigen persistence after radical prostatectomy as a predictive factor of clinical relapse-free survival and overall survival: 10-year data of the ARO 96-02 trial. Int J Radiat Oncol Biol Phys 2015;91:288-94. https://doi.org/10.1016/j.ijrobp.2014.09.039
  15. Rogers CG, Khan MA, Craig Miller M, Veltri RW, Partin AW. Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy. Cancer 2004;101:2549-56. https://doi.org/10.1002/cncr.20637
  16. Moreira DM, Presti JC Jr, Aronson WJ, Terris MK, Kane CJ, Amling CL, et al. Natural history of persistently elevated prostate specific antigen after radical prostatectomy: results from the SEARCH database. J Urol 2009;182:2250-5. https://doi.org/10.1016/j.juro.2009.07.022
  17. Gandaglia G, Boorjian SA, Parker WP, Zaffuto E, Fossati N, Bandini M, et al. Impact of postoperative radiotherapy in men with persistently elevated prostate-specific antigen after radical prostatectomy for prostate cancer: a long-term survival analysis. Eur Urol 2017;72:910-7. https://doi.org/10.1016/j.eururo.2017.06.001
  18. Fossati N, Karnes RJ, Colicchia M, Boorjian SA, Bossi A, Seisen T, et al. Impact of early salvage radiation therapy in patients with persistently elevated or rising prostate-specific antigen after radical prostatectomy. Eur Urol 2018;73:436-44. https://doi.org/10.1016/j.eururo.2017.07.026
  19. Preisser F, Chun FK, Pompe RS, Heinze A, Salomon G, Graefen M, et al. Persistent prostate-specific antigen after radical prostatectomy and its impact on oncologic outcomes. Eur Urol 2019;76:106-14. https://doi.org/10.1016/j.eururo.2019.01.048
  20. Freedland SJ, Isaacs WB, Platz EA, Terris MK, Aronson WJ, Amling CL, et al. Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol 2005;23:7546-54. https://doi.org/10.1200/JCO.2005.05.525
  21. Min SH, Park YH, Lee SB, Ku JH, Kwak C, Kim HH. Impact of prostate size on pathologic outcomes and prognosis after radical prostatectomy. Korean J Urol 2012;53:463-6. https://doi.org/10.4111/kju.2012.53.7.463
  22. Loeb S, Roehl KA, Yu X, Antenor JA, Han M, Gashti SN, et al. Lymphovascular invasion in radical prostatectomy specimens: prediction of adverse pathologic features and biochemical progression. Urology 2006;68:99-103. https://doi.org/10.1016/j.urology.2006.02.004
  23. May M, Kaufmann O, Hammermann F, Loy V, Siegsmund M. Prognostic impact of lymphovascular invasion in radical prostatectomy specimens. BJU Int 2007;99:539-44. https://doi.org/10.1111/j.1464-410X.2006.06650.x
  24. Jamil M, Rakic N, Sood A, Keeley J, Modonutti D, Novara G, et al. Impact of lymphovascular invasion on overall survival in patients with prostate cancer following radical prostatectomy: stage-per-stage analysis. Clin Genitourin Cancer 2021;19: e319-25. https://doi.org/10.1016/j.clgc.2021.04.009
  25. Zhang L, Wu B, Zha Z, Zhao H, Jiang Y, Yuan J. Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies. World J Surg Oncol 2018;16:124.
  26. Hegemann NS, Morcinek S, Buchner A, Karl A, Stief C, Knuchel R, et al. Risk of biochemical recurrence and timing of radiotherapy in pT3a N0 prostate cancer with positive surgical margin: a single center experience. Strahlenther Onkol 2016; 192:440-8. https://doi.org/10.1007/s00066-016-0990-z