Identifying the best candidate for radical prostatectomy among patients with high-risk prostate cancer

Alberto Briganti, Steven Joniau, Paolo Gontero, Firas Abdollah, Niccol M. Passoni, Bertrand Tombal, Giansilvio Marchioro, Burkhard Kneitz, Jochen Walz, Detlef Frohneberg, Chris H. Bangma, Markus Graefen, Alessandro Tizzani, Bruno Frea, R. Jeffrey Karnes, Francesco Montorsi, Hein Van Poppel, Martin Spahn

Research output: Contribution to journalArticlepeer-review

96 Scopus citations


Background: The current role of radical prostatectomy (RP) in patients with high-risk disease remains controversial. Objective: To identify which high-risk prostate cancer (PCa) patients might have favorable pathologic outcomes when surgically treated. Design, setting, and participants: We evaluated 1366 patients with high-risk PCa (ie, at least one of the following risk factors: prostate-specific antigen [PSA] >20 ng/ml, cT3, biopsy Gleason 8-10) treated with RP and pelvic lymph node dissection (PLND) at eight European centers between 1987 and 2009. A favorable pathologic outcome was defined as specimen-confined (SC) disease - namely, pT2-pT3a, node negative PCa with negative surgical margins. Intervention: All patients underwent radical retropubic prostatectomy and PLND. Measurements: Univariable and multivariable logistic regression models tested the association between predictors and SC disease. A logistic regression coefficient-based nomogram was developed and internally validated using 200 bootstrap resamples. The Kaplan-Meier method was used to depict biochemical recurrence (BCR) and cancer-specific survival (CSS) rates. Results and limitations: Overall, 505 of 1366 patients (37%) had SC disease at RP. All preoperative variables (ie, age and PSA at surgery, clinical stage, and biopsy Gleason sum) were independent predictors of SC PCa at RP (all p ≤ 0.04). Patients with SC disease had significantly higher 10-yr BCR-free survival and CSS rates than patients without SC disease at RP (66% vs 47% and 98 vs 88%, respectively; all p < 0.001). A nomogram including PSA, age, clinical stage, and biopsy Gleason sum demonstrated 72% accuracy in predicting SC PCa. This study is limited by its retrospective design and by the lack of an external validation of the nomogram. Conclusions: Roughly 40% of patients with high-risk PCa have SC disease at final pathology. These patients showed excellent long-term outcomes when surgically treated, thus representing the ideal candidates for RP as the primary treatment for PCa. Prediction of such patients is possible using a nomogram based on routinely available clinical parameters.

Original languageEnglish (US)
Pages (from-to)584-592
Number of pages9
JournalEuropean urology
Issue number3
StatePublished - Mar 2012


  • High risk
  • Nomogram
  • Prostate cancer
  • Radical prostatectomy
  • Specimen confined disease

ASJC Scopus subject areas

  • Urology


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