The Predictors of Biochemical Recurrence and Metastasis Following Radical Perineal Prostatectomy in Clinically Localized Prostate Cancer

Hong, Jeong Hee; Lee, Hyun Moo; Choi, Han Yong

Abstract

PURPOSE: We evaluated the predictors of biochemical recurrence (BCR) and clinical progression in order to stratify the risk of developing biologically significant disease following radical perineal prostatectomy (RPP).
MATERIALS AND METHODS
Retrospective data was collected on 198 patients who underwent RPP for the treatment of clinically localized prostate cancer between June 1995 and October 2003. With multivariate analysis using a Cox regression test, several clinical and pathological variables were evaluated for the prediction of BCR following RPP. The probability of BCR-free survival was determined using the Kaplan-Meier method. Using PSA kinetics, the log slope prostate-specific antigen (PSA) was measured in each one of the 168 patients who had either >or= 2 PSA determinations at least 12 months apart following prostatectomy or a great increase of PSA in a brief period after surgery. Log slope PSA, time to BCR and pathologic features were evaluated for the prediction of metastatic progression of prostate cancer after BCR.
RESULTS
Fifty patients (25%) had BCR during a mean follow-up of 30 months (range, 6-102 months). The rates of BCR-free survival at 3 and 5 years were 72% and 66% for the total population, and 91% and 84% for those with pathologically organ confined cancers, respectively. Among several variables, clinical stage, pathology Gleason score, and extraprostatic extension were the significant independent predictors of BCR. In six out of the 50 patients with BCR, distant metastatic progression was noticed. Log slope PSA and time to BCR were the predictors of metastatic progression.
CONCLUSIONS
Pathology Gleason score, clinical stage, and extraprostatic extension were the independent predictor for BCR following RPP. Patients with a high log slope and short time to BCR may be identified early and placed on systemic therapy.