The group identified 1,383 patients with a pathologic Gleason score (GS) ≤6 treated with RP and pelvic lymphadenectomy between 1972 and 2005. Clinical and pathological data and outcomes were prospectively collected and median patient age was 63 years with a median followup of 8.3 years.
PSA was <10ng/ml in 87% of the cohort. About 10% of the cohort were downgraded from biopsy to RP pathology from >6 to ≤6. Organ-confined disease with no lymph node metastasis was found in 1,152 patients (83.3%), pT3a disease with negative lymph nodes in 198 men (16%), and pT3b disease was found in 33 of these 198 men. One patient had pT4 disease, 32 had lymph node metastasis (2%) and 17% had non-organ confined disease. Positive surgical margins were found in 252 patients (18%). GS 6 was found in 66%, and GS5 in 27%. In the more recent era, GS 6 was increasingly the designated GS. Upgrading from GS ≤6 biopsy to GS>6 on RP pathology occurred in almost half of patients. A pre-operative PSA was available in 94% of men, and PSA recurrence decreased over time. Comparing the hazard ratio for clinical recurrence-free survival for RP performed in the eras 1983-1993 vs. 1972-1982 and 1994-2005 vs. 1972-1982 they found HR=0.68 and 0.32, respectively. The HR for RP performed 1983-1993 vs. 1972-1982 was 0.56 and for 1994-2005 vs. 1972-1982 was 0.41. The estimated probability of PSA recurrence was 14% at 10 years and 18% at 15 years. The probabilities of clinical recurrence were 4% and 6% at 10 and 15 years, respectively. Among those affected, median time to PSA progression was 4.1 years and to clinical recurrence was 7.7 years. Thirty-three men had development of distant metastasis and 12 had loco-regional recurrence. At last followup 84.5% of patients were alive. In multivariate analysis, N-stage, T-stage, and surgical margin status were independent variables for PSA recurrence. For overall survival, only age was a significant independent predictor.
Birkhahn M, Penson DF, Cai J, Groshen S, Stein JP, Lieskovsky G, Skinner DG, Cote RJ
BJU Int. 2011 Jan 12. Epub ahead of print.