Departments of Urology and Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria,, Australia.
Australian Prostate Cancer Research Centre Epworth, Richmond, Victoria,, Australia.
BJU Int. 2019 Jun;123(6):976-984. doi: 10.1111/bju.14556. Epub 2018 Oct 19.
To characterise the pattern of late biochemical recurrence (BCR) in the largest contemporary cohort of patients with localised prostate cancer treated with radical prostatectomy (RP) in the active surveillance era.
Consecutive patients who underwent RP for localised prostate cancer between 2003 and 2017 were identified from a prospectively recorded, dedicated prostate cancer database. Patients who received neoadjuvant androgen-deprivation therapy were excluded. These patients were categorised into the following groups: no BCR, BCR at <12 months (early), BCR at 12-60 months (intermediate), and BCR at >60 months (late), after RP. Clinicopathological characteristics were analysed using the Student's t-test, Mann-Whitney U-test, or chi-squared test where appropriate. Multivariable binomial logistic regression models were used to assess predictors of BCR at various time-points.
In all, 2312 patients were included in the final analysis with up to 12 years of follow-up data. The average patient had clinically localised prostate cancer, an elevated PSA level, and International Society of Urological Pathology (ISUP) Grade Group 2 on biopsy. In all, 88.7% of patients had ISUP Grade Group ≥2 at RP. A subgroup of 446 patients had undetectable PSA levels at 5 years after RP; 11.7% of them progressed to experience BCR. In this subgroup, late recurrers had significantly higher-grade tumours on ISUP and Gleason sum (P <0.001 and P = 0.001, respectively), higher rates of extraprostatic extension (P = 0.022), and larger tumour volumes (P = 0.032). Logistic regression showed that RP ISUP Grade Group was a significant predictor of BCR (odds ratio 2.14, 95% confidence interval 1.43-3.20; P <0.001).
This study characterises the pattern of late BCR in the largest contemporary active surveillance era cohort. We have identified that RP ISUP Grade Group is a strong predictive indicator for late BCR. We also propose that timing of BCR resides on a continuum of risk and that the potential concept of dormant micrometastatic involvement requires further research and evaluation.
描述在主动监测时代接受根治性前列腺切除术 (RP) 治疗的局部前列腺癌患者中，最大的当代队列中晚期生化复发 (BCR) 的模式。
从一个前瞻性记录的专门前列腺癌数据库中确定了 2003 年至 2017 年间接受 RP 治疗的局部前列腺癌的连续患者。排除接受新辅助雄激素剥夺治疗的患者。这些患者分为以下几组：无 BCR、BCR<12 个月（早期）、BCR12-60 个月（中期）和 BCR>60 个月（晚期）。使用学生 t 检验、Mann-Whitney U 检验或适当的卡方检验分析临床病理特征。使用多变量二项逻辑回归模型评估不同时间点 BCR 的预测因素。
共有 2312 名患者纳入最终分析，随访时间最长达 12 年。平均患者患有临床局限性前列腺癌，PSA 水平升高，国际泌尿科病理学会 (ISUP) 活检分级组 2。所有患者中，88.7%的患者在 RP 时 ISUP 分级组≥2。446 名患者中有一小部分在 RP 后 5 年 PSA 水平无法检测；其中 11.7%的患者进展为 BCR。在这个亚组中，晚期复发者的 ISUP 和 Gleason 总和的肿瘤分级明显更高（P<0.001 和 P=0.001），前列腺外延伸率更高（P=0.022），肿瘤体积更大（P=0.032）。逻辑回归显示 RP ISUP 分级组是 BCR 的显著预测因素（优势比 2.14，95%置信区间 1.43-3.20；P<0.001）。
本研究描述了最大的当代主动监测时代队列中晚期 BCR 的模式。我们已经确定 RP ISUP 分级组是晚期 BCR 的有力预测指标。我们还提出，BCR 的时间点位于风险连续体上，休眠微转移参与的潜在概念需要进一步研究和评估。
