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Risk Factors for Clinical Metastasis in Men Undergoing Radical Prostatectomy and Immediate Adjuvant Androgen Deprivation Therapy

  • Taguchi, Satoru (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Fukuhara, Hiroshi (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Kakutani, Shigenori (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Takeshima, Yuta (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Miyazaki, Hideyo (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Suzuki, Motofumi (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Fujimura, Tetsuya (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Nakagawa, Tohru (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Igawa, Yasuhiko (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Kume, Haruki (Department of Urology, Graduate School of Medicine, The University of Tokyo) ;
  • Homma, Yukio (Department of Urology, Graduate School of Medicine, The University of Tokyo)
  • Published : 2015.01.22

Abstract

Background: Adjuvant androgen deprivation therapy (ADT) is a treatment option for prostate cancer (PC) patients after radical prostatectomy (RP). Although it can achieve a good progression-free survival rate, some patients still develop clinical metastasis. We here investigated risk factors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Materials and Methods: We identified 197 patients with non-metastatic PC who underwent RP at our institution between 2000 and 2012, followed by adjuvant ADT. The associations of various clinicopathologic factors with clinical metastasis (primary endpoint) and cancer-specific survival (secondary endpoint) were assessed. Multivariate analysis was conducted using a Cox proportional hazards model. Median follow-up was 87 months after RP. Results: Nine (4.6%) patients developed clinical metastasis and six (3.0%) died from PC. Eight of nine metastatic patients had a pathologic Gleason score (GS) 9 and developed bone metastasis, while the remaining one had pathologic GS 7 and developed metastasis only to para-aortic lymph nodes. On multivariate analyses, pathologic GS ${\geq}9$ and regional lymph node metastasis (pN1) were independent predictors of clinical metastasis and pathologic GS ${\geq}9$ was an independent predictor of cancer-specific death. Conclusions: Pathologic GS ${\geq}9$ and pN1 were independent predictors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Furthermore, pathologic GS ${\geq}9$ was an indispensable condition for bone metastasis, which may imply that patients with GS ${\leq}8$ on adjuvant ADT are unlikely to develop bone metastasis.

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