IRCCS Policlinico San Martino Hospital - University of Genova
Introduction: To assess the association between type and number of D’Amico high-risk criteria (DHRCs) with rates of pathologically non-organ confined (NOC) prostate cancer (PCa) in patients treated with radical prostatectomy (RP) and pelvic lymphadenectomy (PLND).
Methods: In the SEER database (2004-2016), we identified 12,961 RP+PLDN patients with at least one DHRC. We relied on descriptive statistics and multivariable logistic regression models.
Results: Of 12,961 patients, 6,135 (47%) exclusively harbored biopsy GS 8-10, 3,526 (27%) had clinical stage = T2c, 1,234 (9.5%) had PSA > 20ng/mL. Only 1,886 (15%) harbored any combination of two DHRCs. Finally, all three DHRCs were present in 180 (1.4%) patients.
NOC rates increased from 32% for clinical T stage = T2c, to 49%, for either GS 8-10 only or PSA>20ng/mL only, to C)66-68% for any combination of two DHRCs, to 84% for respectively all three DHRCs, which resulted in multivariable logistic regression OR of 1.00, vs 2.01 (95% CI 1.85 - 2.19, p<0.001), vs 4.16 (95% CI 3.69- 4.68, p<0.001), vs 10.83 (95% CI 7.35 - 16.52, p<0.001).
Conclusions: Our study indicates a dose-response effect according to the type and number of DHRCs. Specifically, the effect size doubles from the weakest individual DHRC (cT stage = T2c) to stronger individual DHRCs (either GS 8-10 only or PSA>20ng/mL only), it doubles again in presence of any two DHRCs, and finally doubles again in presence of all three DHRCs. In consequence, a formal risk-stratification within high-risk PCa patients should be considered in clinical decision making.