Department of Pathology, Department of Urology Department of Preventive Medicine, Biostatistics Core, University of Southern California Keck School of Medicine, Los Angeles, CA. Department of Urology, Vanderbilt University Medical Center, Nashville, TN; Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Urology, Heilig Geist Krankenhaus, Cologne, Germany.
Study Type - Therapy (individual cohort) Level of Evidence 2b.
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.
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.
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.
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.
Written by:
Birkhahn M, Penson DF, Cai J, Groshen S, Stein JP, Lieskovsky G, Skinner DG, Cote RJ.
Are you the author?
Reference: BJU Int. 2011 Jan 12. Epub ahead of print.
doi: 10.1111/j.1464-410X.2010.09978.x
PubMed Abstract
PMID: 21223479
UroToday.com Prostate Cancer Section
