Prognostic variables associated with biochemical recurrence following radical prostatectomy for pT3b prostate cancer: a research study

Прогностические факторы ассоциированные с биохимическим рецидивом после радикальной простатэктомии у пациентов с карциномой предстательной железы pT3b
Ulanbek Zhanbyrbekuly 1, Jung Kwon Kim 1, Minyong Kang 1, Bumsik Tae 1, Ja Hyun Ku 1, Hyeon Hoe Kim 1, Chang Wook Jeong 1
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1 Department of Urology, Seoul National University Hospital, Seoul, Korea
J CLIN MED KAZ, Volume 1, Issue 47, pp. 29-35.
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Objectives: The objectives of the current study were to determine long-term biochemical recurrence rates stratified by adverse pathologic features and to identify predictive factors of biochemical recurrence rates following radical prostatectomy performed by either retropubic prostatectomy or robot-assisted laparoscopic prostatectomy from single tertiary center prostate cancer database.
Material and Methods: The Seoul National University Hospital prostate cancer database was queried for all patients treated with radical prostatectomy from 1999 to 2015. Among the 2680 patients who underwent radical prostatectomy, 331 patients with seminal vesicle invasion (pathologic T3bN0-1M0 stage) were identified. The primary endpoint was biochemical recurrence, defined as two consecutive postoperative prostate specific antigen values ≥0.2 ng/ml. Comparative analysis based on adverse pathologic characteristics and operation type was performed.
Results: Five and 10-year biochemical recurrence-free survival in the entire cohort was 59.0% and 42.9%. The Kaplan-Meier survival analysis demonstrated 5-year biochemical recurrence free survival rates differences in patients with different lymph node involvement (70.6% vs. 52.4%, log-rank, p=0.01). Variables including age, extracapsular extension, lymph node invasion, surgical margin, perineural invasion, multicentricity and Capra-S score were similar between the groups of patients who underwent either retropubic or robot-assisted laparoscopic radical prostatectomy. The mean prostate specific antigen level, seminal vesicle invasion laterality, tumor volume, and pathologic Gleason score were lower in the cohort of patients who underwent robot-assisted laparoscopic prostatectomy. No statistically significant differences were found in 5-year biochemical recurrence-free survival rates stratified by operation type (58.1% vs. 65%, log-rank, p=0.8), by Capra-S score (72.5% vs. 56.8%, log rank, p=0.1), or by surgical margin status (69.4% vs. 59.3%, log-rank, p=0.8). In univariate and multivariate Cox proportional regression analysis lymph node involvement (p=0.01) was found to be a statistically significant predictor of biochemical recurrence.
Conclusion: Patients with positive lymph node involvement have a poor prognosis. Capra-S score was unable to predict biochemical recurrence in patients with pathologic T3b stage prostate cancer. Robot-assisted laparoscopic prostatectomy is comparable to retropubic radical prostatectomy in terms of the biochemical progression of prostate cancer with seminal vesicle invasion.


Zhanbyrbekuly U, Kim JK, Kang M, Tae B, Ku JH, Kim HH, et al. Prognostic variables associated with biochemical recurrence following radical prostatectomy for pT3b prostate cancer: a research study. Journal of Clinical Medicine of Kazakhstan. 2018;1(47):29-35.


  • Lee HM, Solan MJ, Lupinacci P, Gomella LG, Valicenti RK: Long-term outcome of patients with prostate cancer and pathologic seminal vesicle invasion (pT3b): effect of adjuvant radiotherapy. Urology 2004, 64(1):84-89.
  • D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Schnall M, Tomaszewski JE, Wein A: A multivariate analysis of clinical and pathological factors that predict for prostate specific antigen failure after radical prostatectomy for prostate cancer. The Journal of urology 1995, 154(1):131-138.
  • Bostwick DG, Qian J, Bergstralh E, Dundore P, Dugan J, Myers RP, Oesterling JE: Prediction of capsular perforation and seminal vesicle invasion in prostate cancer. The Journal of urology 1996, 155(4):1361-1367.
  • Pierorazio PM, Ross AE, Schaeffer EM, Epstein JI, Han M, Walsh PC, Partin AW: A contemporary analysis of outcomes of adenocarcinoma of the prostate with seminal vesicle invasion (pT3b) after radical prostatectomy. The Journal of urology 2011, 185(5):1691-1697.
  • Abdollah F, Suardi N, Cozzarini C, Gallina A, Capitanio U, Bianchi M, Sun M, Fossati N, Passoni NM, Fiorino C et al: Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate cancer: a long-term survival analysis. European urology 2013, 63(6):998-1008.
  • Forgues A, Rozet F, Audenet F, Ouzzane A, Sanchez-Salas R, Barret E, Galiano M, Prapotnich D, Cathelineau X: Oncologic outcomes after minimally invasive radical prostatectomy in patients with seminal vesicle invasion (pT3b) without adjuvant therapy. World journal of urology 2014, 32(2):519-524. 
  • Siddiqui SA, Boorjian SA, Blute ML, Rangel LJ, Bergstralh EJ, Karnes RJ, Frank I: Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer. BJU international 2011, 107(3):383-388.
  • Sooriakumaran P, Haendler L, Nyberg T, Gronberg H, Nilsson A, Carlsson S, Hosseini A, Adding C, Jonsson M, Ploumidis A et al: Biochemical recurrence after robot-assisted radical prostatectomy in a European single-centre cohort with a minimum followup time of 5 years. European urology 2012, 62(5):768-774.
  • Liss MA, Lusch A, Morales B, Beheshti N, Skarecky D, Narula N, Osann K, Ahlering TE: Robot-assisted radical prostatectomy: 5-year oncological and biochemical outcomes. The Journal of urology 2012, 188(6):2205-2210.
  • Suardi N, Ficarra V, Willemsen P, De Wil P, Gallina A, De Naeyer G, Schatteman P, Montorsi F, Carpentier P, Mottrie A: Longterm biochemical recurrence rates after robot-assisted radical prostatectomy: analysis of a single-center series of patients with a minimum follow-up of 5 years. Urology 2012, 79(1):133-138.
  • Menon M, Bhandari M, Gupta N, Lane Z, Peabody JO, Rogers CG, Sammon J, Siddiqui SA, Diaz M: Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up. European urology 2010, 58(6):838-846.
  • Rosen MA, Goldstone L, Lapin S, Wheeler T, Scardino PT: Frequency and location of extracapsular extension and positive surgical margins in radical prostatectomy specimens. The Journal of urology 1992, 148(2 Pt 1):331-337.
  • Secin FP, Bianco FJ, Jr., Vickers AJ, Reuter V, Wheeler T, Fearn PA, Eastham JA, Scardino PT: Cancer-specific survival and predictors of prostate-specific antigen recurrence and survival in patients with seminal vesicle invasion after radical prostatectomy. Cancer 2006, 106(11):2369-2375.
  • Stephenson AJ, Kattan MW, Eastham JA, Bianco FJ, Jr., Yossepowitch O, Vickers AJ, Klein EA, Wood DP, Scardino PT: Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2009, 27(26):4300-4305.
  • Pagano MJ, Whalen MJ, Paulucci DJ, Reddy BN, Matulay JT, Rothberg M, Scarberry K, Patel T, Shapiro EY, RoyChoudhury A et al: Predictors of biochemical recurrence in pT3b prostate cancer after radical prostatectomy without adjuvant radiotherapy. The Prostate 2016, 76(2):226-234.
  • Kang DI, Chung JI, Ha HK, Min K, Yoon J, Kim W, Seo WI, Kang P, Jung SJ, Kim IY: Korean prostate cancer patients have worse disease characteristics than their American counterparts. Asian Pacific journal of cancer prevention : APJCP 2013, 14(11):6913- 6917.
  • Bastide C, Rossi D, Lechevallier E, Bladou F, Barriol D, Bretheau D, Grisoni V, Mancini J, Giusiano S, Eghazarian C et al: Seminal vesicle invasion: what is the best adjuvant treatment after radical prostatectomy? BJU international 2012, 109(4):525- 530; discussion 531-522.
  • Sofer M, Savoie M, Kim SS, Civantos F, Soloway MS: Biochemical and pathological predictors of the recurrence of prostatic adenocarcinoma with seminal vesicle invasion. The Journal of urology 2003, 169(1):153-156.
  • Bader P, Burkhard FC, Markwalder R, Studer UE: Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? The Journal of urology 2003, 169(3):849-854.
  • Spahn M, Briganti A, Capitanio U, Kneitz B, Gontero P, Karnes JR, Schubert M, Montorsi F, Scholz CJ, Bader P et al: Outcome predictors of radical prostatectomy followed by adjuvant androgen deprivation in patients with clinical high risk prostate cancer and pT3 surgical margin positive disease. The Journal of urology 2012, 188(1):84-90.
  • Ploussard G, Agamy MA, Alenda O, Allory Y, Mouracade P, Vordos D, Hoznek A, Abbou CC, de la Taille A, Salomon L: Impact of positive surgical margins on prostate-specific antigen failure after radical prostatectomy in adjuvant treatment-naive patients. BJU international 2011, 107(11):1748-1754.
  • Ohori M, Wheeler TM, Kattan MW, Goto Y, Scardino PT: Prognostic significance of positive surgical margins in radical prostatectomy specimens. The Journal of urology 1995, 154(5):1818-1824.
  • Yang Y, Luo Y, Hou GL, Huang QX, Pang J, Gao X: Laparoscopic Radical Prostatectomy Plus Extended Lymph Node Dissection in Combination With Immediate Androgen Deprivation Therapy for Cases of pT3-4N0-1M0 Prostate Cancer: A Multimodal Study of 8 Years’ Follow-up. Clinical genitourinary cancer 2015.
  • Seo WI, Kang PM, Kang DI, Yoon JH, Kim W, Chung JI: Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): ability to predict cancer progression and decision-making regarding adjuvant therapy after radical prostatectomy. Journal of Korean medical science 2014, 29(9):1212-1216.
  • Cooperberg MR, Hilton JF, Carroll PR: The CAPRA-S score: A straightforward tool for improved prediction of outcomes after radical prostatectomy. Cancer 2011, 117(22):5039-5046.
  • Punnen S, Freedland SJ, Presti JC, Jr., Aronson WJ, Terris MK, Kane CJ, Amling CL, Carroll PR, Cooperberg MR: Multiinstitutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy. European urology 2014, 65(6):1171-1177.
  • Punnen S, Meng MV, Cooperberg MR, Greene KL, Cowan JE, Carroll PR: How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU international 2013, 112(4):E314-E320.
  • Pierorazio PM, Mullins JK, Eifler JB, Voth K, Hyams ES, Han M, Pavlovich CP, Bivalacqua TJ, Partin AW, Allaf ME et al: Contemporaneous comparison of open vs minimally-invasive radical prostatectomy for high-risk prostate cancer. BJU international 2013, 112(6):751-757.