Radical prostatectomy and prognostic factors

Prognosis of patients who have been treated by radical prostatectomy, because of prostatic carcinoma, is dependent on a number of factors. In this study we try to determine these factors, their relationship with each other, their relationship with progression of disease and the prognostic value of this relationship.

"Progression" (or relapse) of disease is defined as clinical evidence of local or general recurrence and/or isolated elevation of postoperative PSA level more than 0.2 ng/ml (Hybritech) at two consecutive outpatient visits. In our institution, 62 radical retropubic prostatectomies were performed over a period of 66 months. Without any exclusion, these patients were included in the analysis (with respect to "progression"), which consisted of bi- and multivariate analyses, Kaplan-Meier estimations and multivariate survival analyses using the "Cox proportional hazards model". Median follow-up time was 32 months.

"Progression" was seen in 24.5% of cases, after a median progression-free interval of 13 months. Overall survival and freedom from "progression" (FFP) after 32 months were respectively 98.11% and 81.11%. Significant relations can be demonstrated between on one side preoperative PSA level, and on the other side "progression". FFP after 32 months for pathological T3-T4NO-1 tumors is 67.12% compared to 100% for pathological T2 tumors; FFP after 32 months is 88.98% for Gleason score of resection specimen < 7 and 73.86% for Gleason score > or = 7. Age, preoperative PSA level, Gleason score of resection specimen, surgical margin and 1-month-postoperative PSA level have in our analysis significant value (p < 0.05) in predicting "progression".

Most in the literature described predictive factors for "progression" are fairly well reproduced in our analysis. Elimination of bias from applied (neo-)adjuvant therapy and less heterogeneity of the study group would most certainly improve this reproducibility.