Preoperative MRI and Clinical Factors are Predictors for Biochemical Recurrence in High and Very High Risk Prostate Cancer
Cheng-Kuang Yang, MD1、Chi-Rei Yang, MD2、Yen-Chuan Ou, MD3、Chen-Li Cheng, MD1、Hao-Chung Ho, MD1、Kun-Yuan Chiu, MD1、Shian-Shiang Wang, MD1、Jian-Ri Li, MD1, Chuan-Shu Chen, MD1、Chi-Feng Hung , MD1、Cheng-Che Chen, MD1 、Shu-Chi Wang, MD1、Chia-yen Lin, MD1、Sheng-Chun Hung, MD1
1Devision of Urology, Department of Surgery, Taichung Veterans General Hospital;
2Department of Urology, China Medical University Hospital;
3Department of Urology, Tungs’ Taichung Metro Harbor Hospital.
Purpose: To identify the risk factors for biochemical recurrence (BCR) after radical prostatectomy in patients with high-risk and very high-risk prostate cancer.
Materials and Methods: Retrospective chart review was performed and patients with prostate cancer who underwent radical prostatectomy in one center from January 2009 to June 2020 were included. The information was reviewed from medical record, including demographics, surgery type, PLND status, and PSA value, image stage group, and pathological stage group at diagnosis and after surgery. Follow-up time was longer than 6 years. The primary end point was BCR in one year after surgery.
Results: A total number of 307 patients were included, with 120 in very high-risk group and 187 in high-risk group according to the National Comprehensive Cancer Network (NCCN) guideline. Compared to high-risk group, patients in the very high-risk group experienced poorer BCR-free survival and had a higher rate of BCR for patients with undetectably postoperative PSA, as well as higher risk for postoperative detectable PSA. For patients with undetectably postoperative PSA, BCR was associated with PSA density, image stage group 2 and 3, and pathological stage group 4. Postoperative detectable PSA was associated with pathological stage group 3 and 4.
Conclusion: Among patients with undetectably postoperative PSA, high PSA density, image stage group 2 and 3, and pathological stage group 4 are associated with BCR after prostatectomy, while those with pathological stage group 3 and 4 tumors showed higher risk for postoperative detectable PSA. These findings provide urologists information to decide active therapeutic protocols for patient with prostate cancer.