Surgical treatment of patients with high-risk prostate cancer: long-term outcomes and prognostic factors

Background. Prostate cancer (PCa) remains one of the most relevant problems in oncology. The incidence and mortality of PCa is constantly rising in Russia. The rate of annual increase in the number of new PCa cases is the highest among all malignancies in Russia and reaches 87.7 % over 10 years (from 2008 to 2018). Approximately one-third of patients have high-risk PCa. This article analyzes the outcomes of surgical treatment in high-risk PCa patients.

Objective: to evaluate survival of patients with high-risk PCa after surgical treatment and analyze prognostic factors affecting survival.

Materials and methods. This retrospective study included 1507 high-risk PCa patients who have undergone surgical treatment at P.A. Herzen Moscow Oncology Research Institute. Study participants were divided into groups to assess the effect of preoperative prognostic factors on patient survival after surgery. The following factors were analyzed: level of prostate specific antigen >20 ng/mL, Gleason score 8—10, and сТ3—4 clinical stage.

Results. Median follow-up time was 58 months. The five-year biochemical relapse-free survival rate in the general group was 57.4 %; five-year overall and cancer-specific survival rates were 94.4 % and 97.7 %, respectively. The incidence of biochemical relapses and survival rates depended on the presence and number of risk factors in the groups studied (p <0.0001). The frequency of local relapses and disease progression also depended on the number of risk factors: the more poor prognostic factors the patient had, the lower was the survival.

Conclusion. To find an optimal treatment strategy for high-risk PCa patients after surgery, we recommend using an extended classification (depending on the number of risk factors), since the number of prognostic factors affects survival rates.

1. Pernar C., Ebot E., Wilson K. et al. The Epidemiology of prostate cancer. Cold Spring Harb Perspect Med 2018;8(12):a030361. DOI: 10.1101/cshperspect.a030361.

2. Malignant tumors in Russia in 2018 (morbidity and mortality). Eds.: A.D. Kaprin, V.V. Starinskiy, G.V Petrova. Moscow: MNIOI im. P.A. Gertsena - filial FGBU “NMITS radiologii” Minzdrava Rossii, 2019. 250 p. (In Russ.).

3. Krasheninnikov A.A., Alekseev B.Ya., Nyushko K.M. et al. Treatment of patients with prostate cancer at high risk of its progression. Onkologiya. Zhurnal imeni P.A. Gertsena = P.A. Herzen Journal of Oncology 2019;8(6):460-5. (In Russ.). DOI: 10.17116/onkolog20198061460.

4. State of oncological care in Russia in 2019. Eds.: AD. KapiriinV.V Slariiiskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertsena - filial FGBU “NMITS radiologii” Minzdrava Rossii, 2020. 236 p. (In Russ.).

5. Mottet N., Cornford P., van den Bergh R.C.N. et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol 2020. DOI: 10.1016/j.eururo.2020.09.046.

6. Yaxle, J., Geoffre, D., Suzanne K. et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectom,: earl, outcomes from a randomised controlled phase 3 stud,. Lancet 2016;388:1057. DOI: 10.1016/S0140-6736(16)30592-X.

7. Joniau S., Hsu C., Gontero P. et al. Radical prostatectomy in very high-risk localized prostate cancer: long-term outcomes and outcome predictors. Scand J Urol Nephrol 2012;46:164. DOI: 10.3109/00365599.2011.637956.

8. Ward J.F., Jeffre, M.S., Michael L.B. et al. Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-,ear outcome. BJU Int 2005;95:751. DOI: 10.1111/j.1464-410X.2005.05394.x.

9. Daryalova S.L., Boyio A.V., Aleiseev B.Ya. et al. Methods and results of radiation therapy, for prostate cancer. Rossiyskiy onkologicheskiy, zhurnal = Russian Oncolog, Journal 2006;(6):9-13. (In Russ.).

10. Moris L., Cumberbatch M., van den Broeci T. 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(5):614-27. DOI: 10.1016/j.eururo.2020.01.033.

11. Stranne J., Brasso K., Brennhovd B. et al. SPCG-15: a prospective randomized study comparing primary radical prostatectomy and primary, radiotherapy plus androgen deprivation therapy for locally advanced prostate cancer. Scand J Urol 2018;52(5-6):313-20. DOI: 10.1080/21681805.2018.1520295.

12. Mitchell C.R., Boorjian S.A., Umbreit E.C. et al. 20-Year survival after radical prostatectomy as initial treatment for cT3 prostate cancer. BJU Int 2012;110(11):1709-13. DOI: 10.1111/j.1464-410X.2012.11372.x.

13. Briganti A., Karnes R.J., Gandaglia G. et al. European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT). Natural history of surgically treated high-risk prostate cancer. Urol Oncol 2015;33(4):163.e7-13. DOI: 10.1016/j.urolonc.2014.11.018.

14. Joniau S., Briganti A., Gontero P. et al. European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT). Stratification of high-risk prostate cancer into prognostic categories: a European multi-institutional study. Eur Urol 2015;67(1):157-64. DOI: 10.1016/j.eururo.2014.01.020.

15. Beauval J.B., Roumiguie M., Filleron T. et al. Biochemical recurrence-free survival and pathological outcomes after radical prostatectomy for high-risk prostate cancer. BMC Urol 2016;16(1):26. DOI: 10.1186/s12894-016-0146-6.