Evaluation of D'Amico criteria for low-risk prostate cancer. (August 2013)

• Record Type: Journal Article
• Authors: Milonas, Daimantas; Kinčius, Marius; Skulčius, Giedrius; Matjošaitis, Aivaras Jonas; GudinavičienĖ, Inga; Jievaltas, Mindaugas
• Is Part Of: Scandinavian journal of urology. Volume 48:Number 4(2014)
• Page Start: 344
• Page End: 349
• Publication Date: 2013-08
• Subjects: Urology -- Periodicals; 616.6
• DOI: 10.3109/21681805.2013.870602
• Languages: English
• ISSNs: 2168-1805

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective.</italic> The aim of the study was to identify the risk of unfavourable disease (≥ pT3 and/or Gleason score ≥ 7) in radical prostatectomy (RP) specimens and biochemical progression-free survival (BPFS) after RP in patients with low-risk prostate cancer detected by D'Amico criteria before surgery. <italic>Material and methods.</italic> Between 2004 and 2007, 690 men underwent prostate biopsy and RP at a single university hospital. Of those, 248 patients (35.9%) had low-risk prostate cancer criteria. The endpoints of the study were detection of low-risk (pT2 and Gleason score ≤ 6) or unfavourable (≥ pT3 and/or Gleason score ≥ 7) prostate cancer, and BPFS. The risk of progression was analysed using multivariate Cox regression model and BPFS was established using Kaplan–Meier analysis. <italic>Results.</italic>The median follow-up was 60 months (1–112 months). pT3 was detected in 14.1%, and Gleason score ≥ 7 in 32.7% of patients. Unfavourable prostate cancer was detected in 37.5% of patients. Overall biochemical relapse rate was 13.6%. The estimated probability of 3-, 5- and 8-year BPFS for all study patients was 90.6%, 88.1% and 77.9%, respectively. Eight-year BPFS was 83.3% for low-risk prostate cancer and 68.2% for unfavourable prostate cancer (<italic>p</italic> = 0.007). Positive surgical margins (<italic>p</italic> = 0.0001) and postoperative Gleason score (<italic>p</italic> = 0.023) were the most significant predictors of biochemical relapse in Cox regression analysis. <italic>Conclusions.</italic>The D'Amico criteria may underestimate potentially aggressive prostate cancer in up to 37.5% of patients. Consequently, caution is recommended when the decision concerning the treatment modality is based on D'Amico criteria alone.</p> </abstract>