COMBINED-MODALITY STAGING OF PROSTATE CARCINOMA AND ITS UTILITY IN PREDICTING PATHOLOGICAL STAGE AND POSTOPERATIVE PROSTATE-SPECIFIC ANTIGEN FAILURE

Objectives. This study was performed to predict the factors that can o ptimize preoperative staging for clinically localized prostate cancer patients. Methods. Logistic and Cox regression multivariable analyses were performed on 480 surgically-managed prostate cancer patients to e valuate the ability of clinical stage, prostate specific antigen (PSA) , biopsy Gleason sum, percent positive biopsies, and endorectal coil m agnetic resonance imaging (erMRI) results to predict for pathologic es tablished extracapsular extension (ECE), seminal vesicle invasion (SVI ), and time to post-operative PSA failure. Results. The characteristic s of clinically organ-confined prostate cancer patients at high risk ( >67%) for postoperative PSA failure within 3 years include: (A) PSA >2 0 ng/mL; (B) Biopsy Gleason sum greater than or equal to 8; or (C) erM RI positive for extraprostatic disease and intermediate risk disease. For patients at intermediate risk tie, either a PSA <4 and biopsy Glea son sum of 7; PSA >4 to 10 ng/mL and biopsy Gleason sum 5 to 7; or a P SA >10 to 20 ng/mL and biopsy Gleason sum 2 to 7), despite 100% positi ve biopsies, 50% of patients had pathologic organ-confined disease. Ho wever, in the subset of intermediate-risk patients with a positive erM RI for either ECE or SVI and at least 50% positive biopsies, all had e xtraprostatic disease and failed biochemically by 47 months postoperat ively. Intermediate-risk patients with <50% positive biopsies had path ologic organ-confined disease in at least 77% of the cases. Conclusion s. Combined modality staging using the PSA, biopsy Gleason sum, percen t positive biopsies, and endorectal coil MRI findings in select patien ts can predict pathologic stage and postoperative PSA failure. Therefo re, this combined modality staging may optimize patient selection for phase 3 trials examining the role of neoadjuvant androgen ablative the rapy for patients with clinically localized disease. (C) 1997 by Elsev ier Science Inc.