Contemporary Pathological Stage Distribution After Radical Prostatectomy in North American High-Risk Prostate Cancer Patients

Clin Genitourin Cancer. 2022 Oct;20(5):e380-e389. doi: 10.1016/j.clgc.2022.04.005. Epub 2022 Apr 21.

Abstract

Purpose: To investigate pathological stage at radical prostatectomy (RP) using the "Partin tables" approach in NCCN high-risk (HR) prostate cancer (PCa) patients.

Materials and methods: Within the SEER 2010 to 2016 database, we identified 7,718 NCCN HR PCa patients. Cross-tabulation was used to illustrate the distribution of organ confined disease (OC, pT2), extra-prostatic extension (EPE, pT3a), seminal vesicles invasion (SVI, pT3b), lymph node invasion (LNI, pT2N1), extra-prostatic and lymph node invasion (EPE + LNI, pT3aN1), and seminal vescicale and lymph node invasion (SVI + LNI, pT3bN1), according to preoperative criteria, which consisted in PSA, clinical T stage, biopsy Gleason Score (GS). Binomial 95%CI was constructed for the reported proportions.

Results: Median (IQR) PSA levels was 9 (6-20) ng/ml. The majority of patient harbored cT1c (51%) followed by cT2 (35%) and cT3 (14%) stage. Most patients exhibited GS 4+4 (43%). Overall, 87 vs. 15 vs. 2% of patients harbored only 1 vs. 2 vs. all 3 HR criteria. At RP, OC, EPE, SVI, and LNI rates were respectively 36%, 27%, 17%, and 19%. Highest levels of OC were recorded for cT1c, PSA <10 ng/mL and biopsy GS4+4. Conversely, EPE, SVI and LNI were the highest in patients with cT3, PSA ≥20 ng/mL and GS 5+5. After stratification according to clinical stages, OC rates decreased with increasing PSA levels and GS. Conversely, EPE, SVI and LNI rates increased with increasing PSA and GS.

Conclusion: We provide a lookup table to illustrate the relationship between clinical and pathological characteristics in NCCN HR PCa patients.

Keywords: High-risk prostate cancer; Lookup table; Partin tables; Prostatectomy; SEE; Staging.

MeSH terms

  • Humans
  • Male
  • Neoplasm Staging
  • North America
  • Prostate-Specific Antigen
  • Prostatectomy
  • Prostatic Neoplasms* / pathology
  • Prostatic Neoplasms* / surgery
  • Seminal Vesicles* / pathology

Substances

  • Prostate-Specific Antigen