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JU INSIGHT Biochemical Recurrence in Patients With Grade Group 1 Prostate Cancer With Extraprostatic Extension
By: Michael E. Rezaee, MD, MPH, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Maximilian Pallauf, MD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, University Hospital Salzburg, Paracelsus Medical University, Austria; Sean A. Fletcher, MD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Misop Han, MD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Christian P. Pavlovich, MD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Chien-Kuang Cornelia Ding, MD, PhD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Jonathan I. Epstein, MD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Mohamad E. Allaf, MD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bruce J. Trock, PhD, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, Bloomberg School of Public Health, Johns Hopkins University School of Medicine Baltimore, Maryland; Nirmish Singla, MD, MSCS, FACS, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland | Posted on: 18 Mar 2024
Rezaee ME, Pallauf M, Fletcher SA, et al. Biochemical recurrence in patients with Grade Group 1 prostate cancer with extraprostatic extension. J Urol. 2024;211(3):407-414.
Study Need and Importance
Grade Group (GG) 1 prostate cancer (PCa) is typically associated with clinical indolence and can be safely managed with active surveillance for most patients. However, little is known about oncologic outcomes when these low-risk tumors invade beyond the prostatic capsule. Extraprostatic extension (EPE) is a known independent risk factor for biochemical recurrence (BCR)–free, disease-free, and progression-free survival among ≥ GG2 tumors. However, the oncologic significance of EPE in the setting of pure GG1 disease remains poorly characterized.
What We Found
We conducted a retrospective cohort study of radical prostatectomy patients to examine the association of EPE with BCR in men with GG1 and GG2 PCa treated with radical prostatectomy. For GG1, there was no statistically significant difference in BCR-free survival for men with vs without EPE (subdistribution HR = 0.88; 95% CI: 0.37-2.09; Figure). However, for GG2 patients BCR-free survival was significantly worse for those with vs without EPE (subdistribution HR = 1.97; 95% CI: 1.54-2.52).
Limitations
The limitations of our study include its retrospective design, potential for unmeasured confounding, and infrequent events in patients with GG1 disease.
Interpretation for Patient Care
Our findings suggest that patients with GG1 tumors and EPE experience similar risk of BCR after surgery compared to those without EPE. In addition, our results provide further evidence that GG1 PCa is a low-risk disease process even when tumors invade beyond the prostatic capsule. Future research is needed to understand how EPE may influence the management of GG1 tumors on active surveillance.
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