Risk factors for progression in patients with prostate cancer treated with radical prostatectomy

Adjuvant therapy after radical prostatectomy should ideally be limited to those patients at greatest risk for cancer recurrence, but identification of these patients remains a challenge. Although tumor volume has traditionally been regarded as the most important prognostic factor in patients with localized prostate cancer, a recent multivariate analysis has shown that tumor is not an independent predictor. Moreover, accurate measurement of tumor volume is extremely difficult. Preoperative serum prostate-specific antigen (PSA) levels have been identified as a significant independent predictor of progression. Disease-free survival is significantly better in patients with DNA-diploid prostate cancers than in those with nondiploid tumors. Histological grade is also a powerful predictor of disease progression. As a basis for selecting candidates for adjuvant therapy, clinical staging is too inaccurate and pathological staging too subjective. A recent Mayo Clinic study assessed the value of widely available clinical and laboratory parameters in predicting treatment failure after radical prostatectomy in 904 patients with pathologically organ-confined prostate cancer. Multivariate analysis identified Gleason score, preoperative serum PSA concentration, and DNA ploidy as independent predictors for progression. These risk factors were used to develop a scoring system that allows patients to be classified according to their risk of progression. Patients in the highest risk categories might be targeted for adjuvant therapy and closer surveillance, whereas those at lower risk might be followed less frequently.