1001

RELATIONSHIP BETWEEN PRIMARY GLEASON PATTERN ON NEEDLE BIOPSY AND CLINICOPATHOLOGICAL OUTCOMES AMONG MEN WITH GLEASON 7 ADENOCARCINOMA OF THE PROSTATE

Mark L Gonzalgo*, Patrick J Bastian, Leslie A Mangold, Jonathan I Epstein, Patrick C Walsh, Alan W Partin, Baltimore, MD

INTRODUCTION AND OBJECTIVE: To determine the relationship between needle biopsy primary grade, pathological variables, and post-prostatectomy biochemical recurrence among men with Gleason 7 adenocarcinoma of the prostate. The utility of distinguishing between primary Gleason pattern on needle biopsy among men with Gleason 7 disease has not been well defined.

METHODS: We identified 320 men with Gleason score 7 tumors on needle biopsy treated with radical prostatectomy between 1991 and 2001 by a single surgeon. None of these patients received neoadjuvant or adjuvant hormonal or radiation therapy. The chi-square test and Kaplan-Meier method were used to evaluate the correlation between biopsy Gleason score, pathological outcomes, and biochemical recurrence.

RESULTS: A total of 252 (78.7%) and 68 (21.3%) men had primary Gleason pattern 3 and 4 identified on needle biopsy, respectively. Among patients with Gleason 3 + 4 tumors on biopsy, 76% were primary Gleason grade = 3 while 24% were upgraded to primary pattern = 4 on final pathologic analysis. Among patients with Gleason 4 + 3 tumors on biopsy, 53% were primary pattern = 4 while 47% were downgraded to primary pattern = 3 on final pathologic analysis. Patients with a needle biopsy Gleason score of 3 + 4 were more likely to have capsular penetration if the prostatectomy Gleason score was upgraded (p = 0.004). The actuarial risk of biochemical PSA recurrence was significantly higher among patients with Gleason pattern 4 + 3 on biopsy if the prostatectomy Gleason score was = 4 + 3 compared to = 3 + 4 (p = 0.03).

CONCLUSIONS: Approximately 47% of men with a diagnosis of Gleason 4+3 on needle biopsy will be downgraded to a Gleason sum of = 3 + 4 on final pathologic analysis. This group of patients will have significantly better biochemical PSA recurrence-free outcomes compared to patients diagnosed with Gleason 4 + 3 on biopsy who were not downgraded on final pathologic analysis. These data support the need for identification of additional molecular markers to improve the utility of distinguishing between primary Gleason pattern on needle biopsy among patients with Gleason 7 adenocarcinoma of the prostate.

1002

THE IMPACT OF TIME FROM BIOPSY TO SURGERY ON BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER

Stephen A Boorjian*, Fernando J Bianco, Andrew J Vickers, Peter T Scardino, James A Eastham, New York, NY

INTRODUCTION AND OBJECTIVE: Given the diversity of options available for the treatment of clinically localized prostate cancer, patients often spend time investigating the various therapeutic choices, which may result in a delay in definitive treatment. The impact of a delay in local therapy for prostate cancer has not been well defined. We evaluated the impact of time from biopsy to radical prostatectomy (RP) on postoperative biochemical recurrence (BCR).

METHODS: We retrospectively identified 3,969 consecutive patients who underwent RP for clinically localized prostate cancer from 1987-2002. Patients treated with preoperative radiation, chemotherapy, or hormones were excluded from analysis. The interval between biopsy and surgery was analyzed both as a continuous variable and as a dichotomous variable, split at three months. Multivariate analysis controlling for biopsy Gleason score, pre-biopsy PSA, clinical stage, and year of biopsy was performed to evaluate the impact of time to RP on BCR, defined here as two PSA measurements = 0.4 ng/ml or the initiation of secondary treatment due to a PSA rise. Subset analysis of the impact of time to RP was also performed for patients stratified by the risk group classification as being at high risk of recurrence (PSA>20, Gleason score =8, or T2c disease), and those with a >40% probability of PSA progression based on the preoperative Kattan nomogram.

RESULTS: A total of 3,185 patients met our inclusion criteria, with a mean time from biopsy to RP of 2.3 months (25-75%, 1.6-3.3) and a mean followup after RP of 5.4 years (25-75%, 2.2-7.9). We found that year of biopsy (p<0.01), pre-biopsy PSA (p<0.01), clinical stage (p<0.01), and biopsy Gleason score (p<0.01) were significantly associated with BCR. Time to RP, treated either as a continuous variable (p = 0.842) or when categorized at three months (p = 0.908), failed to predict BCR for the overall cohort. Similarly, time to RP was not an independent predictor of BCR for patients considered to be at high risk of recurrence (p=0.2) or those with a >40% probability of PSA progression based on the Kattan nomogram (p=0.5).

CONCLUSIONS: Pre-biopsy PSA, Gleason score, clinical stage, and year of biopsy were associated with PSA recurrence for clinically localized prostate cancer following RP. Time from biopsy to surgery was not an independent predictor of BCR after RP, even for patients considered to be at high risk of PSA progression either by risk group stratification or by nomogram probability.

1007

PROSTATES GREATER THAN 90 GRAMS ARE ASSOCIATED WITH INCREASED INCONTINENCE AND ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY

John C House*, Fray F Marshall, Decatur, GA

INTRODUCTION AND OBJECTIVE: Recently, prostatic size has been studied in relation to continence and potency outcomes after radical prostatectomy (RP). Specimens above 90 grams are obtained in less than 5% of RPs at our institution.

METHODS: Twenty-eight patients whose RP surgical specimens (prostate with seminal vesicles) weighed 90 grams or greater were compared with a second group consisting of patients whose surgical specimens weighed from 20 to 69 grams. The two groups were matched for age at time of RP. Radical retropubic prostatectomy was performed by one surgeon (FFM) via minilaparotomy incision. Patient and tumor characteristics are summarized in Table 1. Clinical data was determined by chart review. Statistical analysis was performed using VassarStats (http://faculty.vassar.edu).

RESULTS: Patient outcomes are summarized in Table 2. Age, diabetes, and preoperative erectile dysfunction (ED) were not significantly different between the two groups. In comparison with the controls, RP specimens = 90grams were less likely to reveal extraprostatic extension of tumor or Gleason sum above 6. The average weeks of pad use and median weeks to achieve continence doubled in patients with RP specimens = 90grams. The rate of ED was higher in the = 90 gram group.

CONCLUSIONS: A significant increased risk of post-prostatectomy incontinence and ED is seen when RP specimens exceed 90 grams. Appropriate counseling in this setting should include discussion of the significantly increased risks of incontinence and ED at one year postoperatively. Short-term PSA-free survival appears to be similar. We conclude that prostates = 90 grams are associated with increased rates of ED and incontinence. The large prostate may hinder visualization of neurovascular bundles and prostatic apex making RP more difficult. The rhabdosphincter may be splayed or difficult to visualize, and thus at greater risk of injury.

Read Prostate Cancer: Localized Selected Abstracts - Part 6

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