ANALYSIS OF RISK-FACTORS FOR PROGRESSION IN PATIENTS WITH PATHOLOGICALLY CONFINED PROSTATE CANCERS AFTER RADICAL RETROPUBIC PROSTATECTOMY

Purpose: Up to 26% of patients with pathologically organ confined pros tate cancer will experience clinical progression after radical prostat ectomy. We attempted to identify patients at greatest risk for future clinical failure despite a favorable pathological outcome. Materials a nd Methods: The study group included 904 patients treated with bilater al pelvic lymphadenectomy and radical retropubic prostatectomy for dis ease confined to the prostate gland. Preoperative serum prostate speci fic antigen (PSA), clinical stage, pathological grade and stage, and d eoxyribonucleic acid (DNA) ploidy were evaluated by multivariate analy sis to determine relative value in predicting treatment failure. A pro gnostic scoring system was created using the regression coefficients f rom the Cox multivariate model to classify patients further according to risk of progression. Results: Preoperative PSA concentration, clini cal stage, grade and DNA ploidy were significant univariate predictors of progression (p < 0.0001), whereas pathological stage was not (p = 0.2). Multivariate analysis identified pathological grade (p < 0.0001) , preoperative serum PSA concentration (p = 0.0006) and DNA ploidy (p = 0.0089) as independent predictors of progression. The prognostic sco ring system separated the patients into 5 distinct groups. Patients wi th the lowest score had a 92% progression-free survival rate at 5 year s, compared to only 39% of those with the highest scores. Conclusions: Patients believed to be at higher risk for cancer progression despite having organ confined disease might be targeted for adjuvant therapy and closer surveillance, while those at low risk may be followed less often.