MP66-20\u2003ISUP SCORE AS BEST PROGNOSTIC FACTOR FOR PERFORMING LYMPHADENECTOMY DURING RADICAL PROSTATECTOMY FOR BLACK MEN.

Abstract

INTRODUCTION AND OBJECTIVES: Lymphadenectomy is recommended for unfavorable intermediate-risk or high-risk disease, during radical prostatectomy (RP). However, all guidelines have been made with Caucasian people, and data are missing for populations of African descent. The objective is to evaluate biopsy ISUP score alone as a reliable prognostic risk factor for performing lymphadenectomy, in an Afro-Caribbean population. METHODS: We included patients of intermediate and high risk of D’Amico, which had a RP in a retrospective study from a single center cohort study, from an Afro-Caribbean population. Patients were reclassified according to the ISUP score. Survival analyses were calculated with Kaplan-Meier and multivariate analysis was performed using Cox model. RESULTS: 1100 patients were included. There was no significant difference in the biochemical recurrence free survival (BRFS) between the intermediate and high risk groups at 5 years (p=0,89) and at 10 years (p=0,94). By grouping ISUP 1 and 2 compared to ISUP 3, 4 and 5 there was a significant difference with a better BRFS at 5 years (HR = 1,77 ; 95% CI (1,32 - 2,37) ; p < 0,0001) and at 10 years (HR = 1,64 ; 95% CI (1,26 - 2,14) ; p < 0,0001) for ISUP 1 and 2 (Figure 1). By grouping the patients of the ISUP 1 and 2 scores, BRFS was no different whatever the lymphadenectomy status (p=0,75) (Figure 2). In multivariate analysis, high PSA, ISUP score ≥3 on biopsy, pT3a or pT3b stage on operative specimen, and positive surgical margins were risk factors for biochemical recurrence. CONCLUSIONS: Regardless of clinical stage and PSA, ISUP score alone seems to be a safe prognostic factor to indicate lymphadenectomy during RP for Afro-Caribbean people, for intermediate and high risk group prostate cancer. For patients with ISUP score 1 and 2, lymphadenectomy could be avoided. A nomogram for this population should be recommended to confirm our findings. Figure. No caption available. Figure. No caption available. Source of Funding: none