TITLE:
Pathologic and Prognostic Outcomes of Very Low- and Low-Risk Prostate Cancer According to the National Comprehensive Cancer Network Guidelines in Japanese Patients with Radical Prostatectomy
AUTHORS:
Issei Takizawa, Makoto Ohori, Yoshio Ohno, Jun Nakashima, Rie Inoue, Toshitaka Nagao, Masaaki Tachibana
KEYWORDS:
Prostate Cancer, NCCN Guideline, Very Low-Risk, Low-Risk, Active Surveillance
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.4,
March
31,
2016
ABSTRACT: Background: The purpose of this study was to validate the treatment
strategy for a cohort of Japanese patients with very low-risk (VLR) and
low-risk (LR) prostate cancer according to the National Comprehensive Cancer
Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate
cancer treated with radical prostatectomy at our institution between 2000 and
2012. Patients with neoadjuvant treatments were excluded. We retrospectively
reviewed the clinical and pathological outcomes for patients with VLR or LR
prostate cancers that were classified by NCCN guidelines. Results: We
identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical
recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137
patients with LR (p = 0.56). However, none of the 19 patients >65 years old
with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer,
14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years
old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04
and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR
and LR had similarly favorable outcomes, but patients >65 years old with VLR
had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our
results support the treatment strategy of the NCCN that patients with VLR
cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including
active surveillance and aggressive treatments—can be applied to the
remaining patients with VLR or LR cancers.