Predictors of Prostate-Specific Antigen Progression among Men with Seminal Vesicle Invasion at the Time of Radical Prostatectomy

Stephen J. Freedland, William J. Aronson, Joseph C. Presti, Christopher L. Amling, Martha Kennedy Terris, Bruce Trock, Christopher J. Kane

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

BACKGROUND. Seminal vesicle (SV) invasion at the time of radical prostatectomy (RP) generally is considered to be indicative of poor outcome. The authors examined whether there was a subset of men with SV invasion who had long-term prostate-specific antigen (PSA) progression-free survival. METHODS. Data were examined from 1687 men who underwent RP between 1988 and 2002 at 5 equal-access medical centers. Patients were grouped based on the presence or absence of SV invasion at the time of RP. Clinical and pathologic variables as well as biochemical outcome data were compared across the groups using rank-sum, chi-square, and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of time to PSA failure among men with SV invasion. RESULTS. Men with SV invasion had significantly higher PSA values, higher clinical stage, higher grade tumors, and were more likely to have concomitant extracapsular extension or a positive surgical margin. The 5-year PSA progression-free rates for men who had SV invasion was 36%, compared with 70% among men who had no SV invasion. Among men who had SV invasion, using multivariate analysis, only age (P = 0.023), pathologic Gleason score (P = 0.041), and surgical margin status (P = 0.019) were found to be independent predictors of PSA failure. By combining significant prognostic variables, the authors identified a subset of men with SV invasion, low-grade tumors (Gleason score 2-6), and negative surgical margins who had a 5-year PSA progression-free rate of 69%. Men with SV invasion, Gleason scores 2-6 tumors, negative surgical margins, and age ≥60 years (n = 11; 8%) had a 5-year PSA progression-free rate of 100%. CONCLUSIONS. Although the majority of men with SV invasion have high-grade disease and a short time to biochemical failure, the authors identified a subset of men with low-grade disease, negative surgical margins, and older age who, despite SV invasion, had an extremely favorable clinical course. Thus, SV invasion does not uniformly suggest an unfavorable prognosis.

Original languageEnglish (US)
Pages (from-to)1633-1638
Number of pages6
JournalCancer
Volume100
Issue number8
DOIs
StatePublished - Apr 15 2004

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Seminal Vesicles
Prostate-Specific Antigen
Prostatectomy
Neoplasm Grading
Neoplasms
Disease-Free Survival
Multivariate Analysis

Keywords

  • Gleason score
  • Prostate carcinoma
  • Prostate-specific antigen recurrence
  • Radical prostatectomy
  • Seminal vesicle invasion

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Predictors of Prostate-Specific Antigen Progression among Men with Seminal Vesicle Invasion at the Time of Radical Prostatectomy. / Freedland, Stephen J.; Aronson, William J.; Presti, Joseph C.; Amling, Christopher L.; Terris, Martha Kennedy; Trock, Bruce; Kane, Christopher J.

In: Cancer, Vol. 100, No. 8, 15.04.2004, p. 1633-1638.

Research output: Contribution to journalArticle

Freedland, Stephen J. ; Aronson, William J. ; Presti, Joseph C. ; Amling, Christopher L. ; Terris, Martha Kennedy ; Trock, Bruce ; Kane, Christopher J. / Predictors of Prostate-Specific Antigen Progression among Men with Seminal Vesicle Invasion at the Time of Radical Prostatectomy. In: Cancer. 2004 ; Vol. 100, No. 8. pp. 1633-1638.
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abstract = "BACKGROUND. Seminal vesicle (SV) invasion at the time of radical prostatectomy (RP) generally is considered to be indicative of poor outcome. The authors examined whether there was a subset of men with SV invasion who had long-term prostate-specific antigen (PSA) progression-free survival. METHODS. Data were examined from 1687 men who underwent RP between 1988 and 2002 at 5 equal-access medical centers. Patients were grouped based on the presence or absence of SV invasion at the time of RP. Clinical and pathologic variables as well as biochemical outcome data were compared across the groups using rank-sum, chi-square, and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of time to PSA failure among men with SV invasion. RESULTS. Men with SV invasion had significantly higher PSA values, higher clinical stage, higher grade tumors, and were more likely to have concomitant extracapsular extension or a positive surgical margin. The 5-year PSA progression-free rates for men who had SV invasion was 36{\%}, compared with 70{\%} among men who had no SV invasion. Among men who had SV invasion, using multivariate analysis, only age (P = 0.023), pathologic Gleason score (P = 0.041), and surgical margin status (P = 0.019) were found to be independent predictors of PSA failure. By combining significant prognostic variables, the authors identified a subset of men with SV invasion, low-grade tumors (Gleason score 2-6), and negative surgical margins who had a 5-year PSA progression-free rate of 69{\%}. Men with SV invasion, Gleason scores 2-6 tumors, negative surgical margins, and age ≥60 years (n = 11; 8{\%}) had a 5-year PSA progression-free rate of 100{\%}. CONCLUSIONS. Although the majority of men with SV invasion have high-grade disease and a short time to biochemical failure, the authors identified a subset of men with low-grade disease, negative surgical margins, and older age who, despite SV invasion, had an extremely favorable clinical course. Thus, SV invasion does not uniformly suggest an unfavorable prognosis.",
keywords = "Gleason score, Prostate carcinoma, Prostate-specific antigen recurrence, Radical prostatectomy, Seminal vesicle invasion",
author = "Freedland, {Stephen J.} and Aronson, {William J.} and Presti, {Joseph C.} and Amling, {Christopher L.} and Terris, {Martha Kennedy} and Bruce Trock and Kane, {Christopher J.}",
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T1 - Predictors of Prostate-Specific Antigen Progression among Men with Seminal Vesicle Invasion at the Time of Radical Prostatectomy

AU - Freedland, Stephen J.

AU - Aronson, William J.

AU - Presti, Joseph C.

AU - Amling, Christopher L.

AU - Terris, Martha Kennedy

AU - Trock, Bruce

AU - Kane, Christopher J.

PY - 2004/4/15

Y1 - 2004/4/15

N2 - BACKGROUND. Seminal vesicle (SV) invasion at the time of radical prostatectomy (RP) generally is considered to be indicative of poor outcome. The authors examined whether there was a subset of men with SV invasion who had long-term prostate-specific antigen (PSA) progression-free survival. METHODS. Data were examined from 1687 men who underwent RP between 1988 and 2002 at 5 equal-access medical centers. Patients were grouped based on the presence or absence of SV invasion at the time of RP. Clinical and pathologic variables as well as biochemical outcome data were compared across the groups using rank-sum, chi-square, and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of time to PSA failure among men with SV invasion. RESULTS. Men with SV invasion had significantly higher PSA values, higher clinical stage, higher grade tumors, and were more likely to have concomitant extracapsular extension or a positive surgical margin. The 5-year PSA progression-free rates for men who had SV invasion was 36%, compared with 70% among men who had no SV invasion. Among men who had SV invasion, using multivariate analysis, only age (P = 0.023), pathologic Gleason score (P = 0.041), and surgical margin status (P = 0.019) were found to be independent predictors of PSA failure. By combining significant prognostic variables, the authors identified a subset of men with SV invasion, low-grade tumors (Gleason score 2-6), and negative surgical margins who had a 5-year PSA progression-free rate of 69%. Men with SV invasion, Gleason scores 2-6 tumors, negative surgical margins, and age ≥60 years (n = 11; 8%) had a 5-year PSA progression-free rate of 100%. CONCLUSIONS. Although the majority of men with SV invasion have high-grade disease and a short time to biochemical failure, the authors identified a subset of men with low-grade disease, negative surgical margins, and older age who, despite SV invasion, had an extremely favorable clinical course. Thus, SV invasion does not uniformly suggest an unfavorable prognosis.

AB - BACKGROUND. Seminal vesicle (SV) invasion at the time of radical prostatectomy (RP) generally is considered to be indicative of poor outcome. The authors examined whether there was a subset of men with SV invasion who had long-term prostate-specific antigen (PSA) progression-free survival. METHODS. Data were examined from 1687 men who underwent RP between 1988 and 2002 at 5 equal-access medical centers. Patients were grouped based on the presence or absence of SV invasion at the time of RP. Clinical and pathologic variables as well as biochemical outcome data were compared across the groups using rank-sum, chi-square, and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of time to PSA failure among men with SV invasion. RESULTS. Men with SV invasion had significantly higher PSA values, higher clinical stage, higher grade tumors, and were more likely to have concomitant extracapsular extension or a positive surgical margin. The 5-year PSA progression-free rates for men who had SV invasion was 36%, compared with 70% among men who had no SV invasion. Among men who had SV invasion, using multivariate analysis, only age (P = 0.023), pathologic Gleason score (P = 0.041), and surgical margin status (P = 0.019) were found to be independent predictors of PSA failure. By combining significant prognostic variables, the authors identified a subset of men with SV invasion, low-grade tumors (Gleason score 2-6), and negative surgical margins who had a 5-year PSA progression-free rate of 69%. Men with SV invasion, Gleason scores 2-6 tumors, negative surgical margins, and age ≥60 years (n = 11; 8%) had a 5-year PSA progression-free rate of 100%. CONCLUSIONS. Although the majority of men with SV invasion have high-grade disease and a short time to biochemical failure, the authors identified a subset of men with low-grade disease, negative surgical margins, and older age who, despite SV invasion, had an extremely favorable clinical course. Thus, SV invasion does not uniformly suggest an unfavorable prognosis.

KW - Gleason score

KW - Prostate carcinoma

KW - Prostate-specific antigen recurrence

KW - Radical prostatectomy

KW - Seminal vesicle invasion

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