Favorable Intermediate-Risk Prostate Cancer Leads to Worse Survival Compared to Low-Risk Patients due to Adverse Pathology
Intermediate-risk (IR) prostate cancer is a heterogenous classification. While potential favorable criteria have been proposed to guide treatment decisions, recent evidence suggests rates of adverse pathology are not comparable to low-risk (LR) patients. Preoperative clinical stage and Grade Group (GG) on needle biopsy are often upstaged or upgraded on surgical pathology. Therefore, we aimed to quantify the rate of adverse surgical pathology and implications for survival for patients with favorable IR versus LR prostate cancer.
The National Cancer Database was queried to identify patients undergoing radical prostatectomy (RP) with data on biopsy and surgical pathology from 2009-2013. Baseline and pathologic outcomes were compared for patients meeting clinically LR (GG1(3+3), ≤cT2a, PSA
A total of 3,519 (6.8%) of 51,688 LR and 8,888 (20.8%) of 42,720 GG2 IR patients included were found to have adverse pathologic findings (RR 3.06 (95%CI 2.95-3.17; p
Adverse pathology is observed at a three-fold higher rate for patients classified as favorable IR compared to LR. The presence of adverse pathologic findings led to worse survival for men in the favorable IR risk group; favorable IR men as a whole experienced worse survival relative to LR men.