Biochemical Recurrence After Radical Prostatectomy With or Without Pelvic Lymphadenectomy in Korean Men With High-risk Prostate Cancer

Objective: To identify predictors of biochemical recurrence (BCR) after radical prostatectomy with or without standard pelvic lymphadenectomy in Korean men with high-risk prostate cancer. Methods: The clinical and pathologic data of 199 patients with high-risk features were reviewed retrospectively. High-risk features were prostate-specific antigen level >20 ng/ml, biopsy Gleason score >= 8 or clinical tumor category >= 2c. All patients were followed up by measuring their prostate-specific antigen levels every 3 months. The median follow-up period was 37.0 months (range: 1.0-143.0). Results: During the follow-up period, biochemical recurrence was observed in 68 patients (34.2%). The 1-, 3- and 5-year biochemical recurrence-free survival rates were 79.6, 61.9 and 49.2%, respectively. Surgical Gleason score >= 8, positive surgical margin, extracapsular extension, and seminal vesicle invasion correlated significantly with biochemical recurrence-free survival (all P < 0.05), but pelvic lymphadenectomy did not. Multivariate Cox's proportional hazard analysis revealed that the only significant independent prognostic factor of biochemical recurrence-free survival was seminal vesicle invasion (P = 0.035, relative risk = 1.81). Conclusions: Men with seminal vesicle invasion appear to have a significantly higher biochemical recurrence risk in patients with high-risk prostate cancer. However, since the natural history of prostate cancer is variable and accurate means of identifying those who will progress are currently available, it will be necessary to conduct further studies to find prognostic parameters that will allow the early identification of high-risk patients who could benefit from early salvage or adjuvant therapy.