Expression of P21 predicts PSA failure in locally advanced prostate cancertreated by prostatectomy

The management of prostate cancer is based on several clinicopathological c riteria. The ability to determine the tumor's biological potential is one g oal of tumor markers in order to identify patients who may require more int ensive treatment strategies. The purpose of our study was to determine if p 21/(WAF1/CIP1) expression can predict biochemical failure in patients with locally advanced prostate cancer treated by radical retropubic prostatectom y (RRP), We used immunohistochemistry to analyze patterns of p21 expression in a population of 296 patients with locally advanced (pT3) prostate cance r treated by RRP, Results were correlated with clinicopathological paramete rs and time to PSA failure. For the entire cohort of 296 patients, after ad justment for prognostic factors, p21 expression was associated with an incr eased risk of PSA failure (relative risk [RR] = 1.48) of statistical signif icance at a median follow-up of 54.5 months, Other parameters that independ ently predicted the risk of PSA failure included lymph node metastasis and seminal vesicle involvement. Because neoadjuvant hormonal therapy (NHT) is known to lead to involutional changes in prostatic carcinoma, we performed multivariate analyses after stratifying for NHT prior to surgery. Among the 172 patients treated by RRP alone, p21 expression was an independent predi ctor of PSA failure (RR = 2.30), as were lymph node metastases (RR = 3.19) and pathological grade 5-7 and 8-10 (RR = 2.87 and 3.50, respectively), p21 over-expression is an independent predictor of PSA failure in pT3 patients treated by radical prostatectomy, especially if they did not receive NHT. This tumor marker may help clinicians identify patients who may require adj uvant treatment strategies following radical prostatectomy. (C) 2001 Wiley- Liss, Inc.