Margin-Positive Radical Prostatectomy: All High Risk? PSA Relapse Risk Subset Identification via Recursive Partitioning AnalysisMitchell DL1, Russo JK2, Mott SL3, Snow AN4, Tracy CR5, Buatti JM6 and Watkins JM6*
- Corresponding Author:
- Watkins JM
University of Iowa, Carver College of Medicine
Department of Radiation Oncology, 200 Hawkins Drive
Iowa City, Iowa, 52242, USA
E-mail: [email protected]
Received Date: October 26, 2016; Accepted Date: October 27, 2016; Published Date: November 15, 2016
Citation: Mitchell DL, Russo JK, Mott SL, Snow AN, Tracy CR, Buatti JM and Watkins JM (2016) Margin-Positive Radical Prostatectomy: All High Risk? PSA Relapse Risk Subset Identification via Recursive Partitioning Analysis. J Pros Canc 1:110.
Copyright: © 2016 Mitchell DL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives: To stratify risk of PSA relapse in a large population of men with positive surgical margin(s) at radical prostatectomy for prostate cancer.
Methods: A multi-institutional retrospective analysis of patient-and tumor-specific factor association with PSA (biochemical) relapse-free survival is reported. Eligible patients underwent radical prostatectomy for clinically localized prostate cancer, without pathologic involvement of seminal vesicles or lymph nodes, and >1 site of cancer involvement at the surgical margin. Patients were excluded for pre-prostatectomy PSA >30 or adjuvant (nonsalvage) radiotherapy or hormone therapy. PSA failure was defined as PSA >0.10 ng/mL and rising, or at salvage intervention. Kaplan-Meier method was employed for survival estimates; recursive partitioning analysis by conditional inference analysis was applied to identify variables associated with PSA relapse-free survival.
Results: Between 2002 and 2010, 215 patients with margin-positive prostatectomy were eligible for analysis. The median age at diagnosis was 61 years (range, 43 years to 76 years), and median pre-prostatectomy PSA was 5.8 ng/mL (1.6-26.0). At a median follow-up of 78 months (14 months to 155 months; with 42% followed >8 years), 85 patients had experienced PSA relapse. At multivariable analysis, primary Gleason grade, pT-stage, and initial postprostatectomy PSA were significant. Recursive partitioning analysis yielded 3 discrete risk groups, including a lowerrisk group with 78% PSA relapse-free survival at 5 years (initial post-prostatectomy PSA <0.1, Gleason score <7).
Conclusion: Among patients with margin-positive prostatectomy, Gleason score and initial post-prostatectomy PSA permitted risk substratification for PSA relapse-free survival.