Pretreatment Tables Predicting Pathologic Stage of Locally Advanced Prostate Cancer
Menée sur une cohorte de 759 patients atteints d'un cancer de la prostate de stade cT3a traité entre 1987 et 2010, cette étude rétrospective multicentrique évalue la performance de tables, incorporant le niveau du PSA avant traitement et le score de Gleason à la biopsie, pour prédire le stade pathologique après une prostatectomie radicale
Background : Pretreatment tables for the prediction of pathologic stage have been published and validated for localized prostate cancer (PCa). No such tables are available for locally advanced (cT3a) PCa.
Objective : To construct tables predicting pathologic outcome after radical prostatectomy (RP) for patients with cT3a PCa with the aim to help guide treatment decisions in clinical practice.
Design, setting, and participants : This was a multicenter retrospective cohort study including 759 consecutive patients with cT3a PCa treated with RP between 1987 and 2010.
Intervention : Retropubic RP and pelvic lymphadenectomy.
Outcome measurements and statistical analysis : Patients were divided into pretreatment prostate-specific antigen (PSA) and biopsy Gleason score (GS) subgroups. These parameters were used to construct tables predicting pathologic outcome and the presence of positive lymph nodes (LNs) after RP for cT3a PCa using ordinal logistic regression.
Results and limitations : In the model predicting pathologic outcome, the main effects of biopsy GS and pretreatment PSA were significant. A higher GS and/or higher PSA level was associated with a more unfavorable pathologic outcome. The validation procedure, using a repeated split-sample method, showed good predictive ability. Regression analysis also showed an increasing probability of positive LNs with increasing PSA levels and/or higher GS. Limitations of the study are the retrospective design and the long study period.
Conclusions : These novel tables predict pathologic stage after RP for patients with cT3a PCa based on pretreatment PSA level and biopsy GS. They can be used to guide decision making in men with locally advanced PCa.
Patient summary : Our study might provide physicians with a useful tool to predict pathologic stage in locally advanced prostate cancer that might help select patients who may need multimodal treatment.
Take Home Message : We constructed novel tables based on pretreatment prostate-specific antigen level and biopsy Gleason score for the prediction of pathologic stage, positive lymph nodes, and positive margins in locally advanced prostate cancer. These may be used for patient counseling by urologists and radiation oncologists.
European Urology , résumé, 2013