What risk factors can influence surgery success in high-risk prostate cancer patients?

This study identified risk factors in high-risk prostate cancer patients that could influence the success of radical prostatectomy (RP).

Prostate cancer is a cancer of the prostate gland that makes up part of the male reproductive system. Though the majority of men will not die from this cancer, some forms can be aggressive and may spread.

RP is one of the main treatments a patient will receive; this involves surgically removing the prostate gland. Though the results from RP are mostly positive, some patients may require further treatment after surgery. This may be due to risk factors in certain patients that would class them as low, intermediate or high-risk.

Recent studies suggest that high-risk prostate cancer patients can be split in to two groups; unfavorable and favorable – depending on the risk factors present. 

The following article aims to highlight these risk factors in a bid to predict high-risk prostate cancer outcomes following RP treatment.

The records of 1,905 patients who had RP surgery were used in this study. Of these, 546 (28.66%) patients were considered high-risk (based on a standard classification system).  This group was further divided in to two categories; unfavorable and favorable based on the following two risk factors: Gleason pattern 5 (indicates completely abnormal cells) or the presence of 2 of the following 3 high-risk criteria; T3a/b tumor (growth outside prostate into other tissue), T4 tumor (growth into rectum, surrounding muscles and/or the wall of the pelvis), or prostate specific antigen (PSA) level > 20 ng/ml (protein that measures the progression of the cancer). The average follow-up after surgery was 45.1 months.

Patients who met at least one of these two risk factors were considered unfavorable high-risk patients (196 patients, 35.9%) while all other patients were considered favorable high-risk patients (350 patients, 64.1%). Significantly more patients in the favourable group (56.35%) achieved 5-year biochemical recurrence-free survival (no increase in PSA levels within 5 years of treatment) in comparison to the unfavorable group (18.75%). Patients in the unfavorable group with only one risk factor had a higher BCR survival rate (86.4%) than those who had both (60%).

The authors concluded that even within high-risk patients, outcomes are significantly different. They suggest improving the risk classification system to help choose the best treatment for each individual.

The small sized group included RP only patients so the results may not be similar for those undergoing radiotherapy or systemic therapy.

If you are a high-risk patient, consider the two risk factors as outlined in this study when discussing treatment options with your doctor.