Long-term outcome in patients with a Gleason score ≤ 6 prostate cancer treated by radical prostatectomy.

Abstract

OBJECTIVE:

• To determine the actual recurrence risk of patients with a Gleason score (GS) ≤ 6 treated with radical retropubic prostatectomy (RRP) and bilateral lymphadenectomy in a cohort with long-term follow-up.

PATIENTS AND METHODS:

• The USC/Norris Comprehensive Cancer Center database included 3235 consecutive patients who underwent RRP for prostate cancer between January 1972 and December 2005. We identified 1383 patients with a GS ≤ 6 in prostatectomy specimens. Median follow-up was 8.3 years. Data on pathological and clinical characteristics and outcome were prospectively recorded. • Statistical analysis was performed using the stratified log-rank test and stepwise Cox regression analysis.

RESULTS:

• A GS of 6 was present in 66%, 5 in 27%, 4 in 5% and 3 or 2 in 3% of cases. Tumour classification was pT2N0 (83%), pT3N0 (14%), pT4N0 (0.1%) and any TN1 (2%). • Positive margins were seen in 18%. Estimated PSA and clinical recurrence rate were 14% and 4% after 10 years and 18% and 6% after 15 years, respectively. In multivariate analysis, N-stage (P < 0.001), T-stage (P= 0.02) and margin status (P < 0.001) were associated with PSA recurrence. • N-stage (P < 0.001) and T-stage (P= 0.01) were associated with clinical recurrence. • Overall, patients with a GS ≤ 6 accounted for 26% of all PSA recurrences and for 20% of all patients with clinical recurrences in the database.

CONCLUSION:

• A relatively small proportion of patients with a GS ≤ 6 cancer developed PSA recurrence and/or overt metastasis. However, these patients account for a substantial minority of those who experienced recurrence and metastasis.

• Authors: Marc Birkhahn, David F Penson, Jie Cai, Susan Groshen, John P Stein, Gary Lieskovsky, Donald G Skinner, Richard J Cote
• Journal: BJU international (BJU Int) Vol. 108 Issue 5 Pg. 660-4 (Sep 2011) ISSN: 1464-410X [Electronic] England
• PMID: 21223479 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.

Topics

• Adult
• Aged
• Aged, 80 and over
• Biopsy, Needle
• Disease-Free Survival
• Follow-Up Studies
• Humans
• Lymph Node Excision
• Male
• Middle Aged
• Neoplasm Recurrence, Local (pathology, surgery)
• Neoplasm Staging
• Prognosis
• Prostatectomy (methods)
• Prostatic Neoplasms (pathology, surgery)
• Risk Factors
• Time Factors
• Treatment Outcome