Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review.
- Van den Broeck T Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium. Electronic address: vandenbroeck.thomas@gmail.com.
- van den Bergh RCN Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Arfi N Department of Urology, Hospital Saint Luc Saint Joseph, Lyon, France.
- Gross T Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
- Moris L Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium.
- Briers E Hasselt, Belgium.
- Cumberbatch M Academic Urology Unit, University of Sheffield, Sheffield, UK.
- De Santis M Charite Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria.
- Tilki D Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
- Fanti S Nuclear Medicine Division, Policlinico S. Orsola, University of Bologna, Italy.
- Fossati N Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
- Gillessen S Division of Cancer Sciences, University of Manchester and The Christie, Manchester, UK; Department of Oncology and Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland; University of Bern, Bern, Switzerland.
- Grummet JP Department of Surgery, Central Clinical School, Monash University, Caulfield North, Victoria, Australia.
- Henry AM Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK.
- Lardas M Department of Urology, Leto Hospital, Athens, Greece.
- Liew M Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK.
- Rouvière O Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France.
- Pecanka J Pecanka Consulting Services, Prague, Czech Republic; Department of Biomedical Data Sciences, University Medical Center, Leiden, The Netherlands.
- Mason MD Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK.
- Schoots IG Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- van Der Kwast TH Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands.
- van Der Poel HG Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Wiegel T Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
- Willemse PM Department of Urology, University Hospital Groningen, Groningen, The Netherlands.
- Yuan Y Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Lam TB Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
- Cornford P Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.
- Mottet N Department of Urology, University Hospital, St. Etienne, France.
- 2018-10-22
Published in:
- European urology. - 2019
Biochemical recurrence
European Association of Urology
Gleason score
Guidelines
PSA kinetics
Prognostic factors
Prostate cancer
Radical prostatectomy
Radiotherapy
Systematic review
Humans
Kallikreins
Male
Neoplasm Recurrence, Local
Prognosis
Prostate-Specific Antigen
Prostatic Neoplasms
Survival Rate
English
CONTEXT
In men with prostate cancer (PCa) treated with curative intent, controversy exists regarding the impact of biochemical recurrence (BCR) on oncological outcomes.
OBJECTIVE
To perform a systematic review of the existing literature on BCR after treatment with curative intent for nonmetastatic PCa. Objective 1 is to investigate whether oncological outcomes differ between patients with or without BCR. Objective 2 is to study which clinical factors and tumor features in patients with BCR have an independent prognostic impact on oncological outcomes.
EVIDENCE ACQUISITION
Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. For objective 1, prospective and retrospective studies comparing survival outcomes of patients with or without BCR following radical prostatectomy (RP) or radical radiotherapy (RT) were included. For objective 2, all studies with at least 100 participants and reporting on prognostic patient and tumor characteristics in patients with BCR were included. Risk-of-bias and confounding assessments were performed according to the Quality in Prognosis Studies tool. Both a narrative synthesis and a meta-analysis were undertaken.
EVIDENCE SYNTHESIS
Overall, 77 studies were included for analysis, of which 14 addressed objective 1, recruiting 20 406 patients. Objective 2 was addressed by 71 studies with 29 057, 11 301, and 4272 patients undergoing RP, RT, and a mixed population (mix of patients undergoing RP or RT as primary treatment), respectively. There was a low risk of bias for study participation, confounders, and statistical analysis. For most studies, attrition bias, and prognostic and outcome measurements were not clearly reported. BCR was associated with worse survival rates, mainly in patients with short prostate-specific antigen doubling time (PSA-DT) and a high final Gleason score after RP, or a short interval to biochemical failure (IBF) after RT and a high biopsy Gleason score.
CONCLUSIONS
BCR has an impact on survival, but this effect appears to be limited to a subgroup of patients with specific clinical risk factors. Short PSA-DT and a high final Gleason score after RP, and a short IBF after RT and a high biopsy Gleason score are the main factors that have a negative impact on survival. These factors may form the basis of new BCR risk stratification (European Association of Urology BCR Risk Groups), which needs to be validated formally.
PATIENT SUMMARY
This review looks at the risk of death in men who shows rising prostate-specific antigen (PSA) in the blood test performed after curative surgery or radiotherapy. For many men, rising PSA does not mean that they are at a high risk of death from prostate cancer in the longer term. Men with PSA that rises shortly after they were treated with radiotherapy or rapidly rising PSA after surgery and a high tumor grade for both treatment modalities are at the highest risk of death. These factors may form the basis of new risk stratification (European Association of Urology biochemical recurrence Risk Groups), which needs to be validated formally.
In men with prostate cancer (PCa) treated with curative intent, controversy exists regarding the impact of biochemical recurrence (BCR) on oncological outcomes.
OBJECTIVE
To perform a systematic review of the existing literature on BCR after treatment with curative intent for nonmetastatic PCa. Objective 1 is to investigate whether oncological outcomes differ between patients with or without BCR. Objective 2 is to study which clinical factors and tumor features in patients with BCR have an independent prognostic impact on oncological outcomes.
EVIDENCE ACQUISITION
Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. For objective 1, prospective and retrospective studies comparing survival outcomes of patients with or without BCR following radical prostatectomy (RP) or radical radiotherapy (RT) were included. For objective 2, all studies with at least 100 participants and reporting on prognostic patient and tumor characteristics in patients with BCR were included. Risk-of-bias and confounding assessments were performed according to the Quality in Prognosis Studies tool. Both a narrative synthesis and a meta-analysis were undertaken.
EVIDENCE SYNTHESIS
Overall, 77 studies were included for analysis, of which 14 addressed objective 1, recruiting 20 406 patients. Objective 2 was addressed by 71 studies with 29 057, 11 301, and 4272 patients undergoing RP, RT, and a mixed population (mix of patients undergoing RP or RT as primary treatment), respectively. There was a low risk of bias for study participation, confounders, and statistical analysis. For most studies, attrition bias, and prognostic and outcome measurements were not clearly reported. BCR was associated with worse survival rates, mainly in patients with short prostate-specific antigen doubling time (PSA-DT) and a high final Gleason score after RP, or a short interval to biochemical failure (IBF) after RT and a high biopsy Gleason score.
CONCLUSIONS
BCR has an impact on survival, but this effect appears to be limited to a subgroup of patients with specific clinical risk factors. Short PSA-DT and a high final Gleason score after RP, and a short IBF after RT and a high biopsy Gleason score are the main factors that have a negative impact on survival. These factors may form the basis of new BCR risk stratification (European Association of Urology BCR Risk Groups), which needs to be validated formally.
PATIENT SUMMARY
This review looks at the risk of death in men who shows rising prostate-specific antigen (PSA) in the blood test performed after curative surgery or radiotherapy. For many men, rising PSA does not mean that they are at a high risk of death from prostate cancer in the longer term. Men with PSA that rises shortly after they were treated with radiotherapy or rapidly rising PSA after surgery and a high tumor grade for both treatment modalities are at the highest risk of death. These factors may form the basis of new risk stratification (European Association of Urology biochemical recurrence Risk Groups), which needs to be validated formally.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.eururo.2018.10.011
- PMID 30342843
- Persistent URL
- https://sonar.rero.ch/global/documents/247620
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