A. Gómez-Iturriaga, Á. Cabeza, Jorge Rafael Pastor Peidro, J. Jové Teixidó, M. Casaña Giner, A.G. Caamaño, J.L. Mengual Cloquell, I. Henríquez, Julia Luisa Muñoz García, Asunción Hervás Morón, Carmen González San Segundo
Purpose To report treatment outcomes in a cohort of extreme-risk prostate cancer patients and identify a subgroup of patients with worse prognosis.
Materials and methods Extreme-risk prostate cancer patients were defined as patients with at least one extreme-risk factor: stage cT3b–cT4, Gleason score 9–10 or PSA > 50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c–cT3a, Gleason 8 and PSA > 20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical-free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients.
Results With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariate analysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the “number of risk factors” variable, this model provided the best distinction between patients with ≥2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint.
Conclusions Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments.
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