Editor's Commentary - Long-term outcome in patients with a Gleason score ≤ 6 prostate cancer treated by radical prostatectomy

BERKELEY, CA (UroToday.com) - Patients with Gleason score 6 or less prostate cancer (CaP) treated with radical prostatectomy (RP) are unlikely to have a PSA recurrence or metastasis according to a report from the USC/Norris Comprehensive Cancer Center database that appears in the online version of the British Journal of Urology International.

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.

PubMed Abstract
PMID: 21223479

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