Pathologic gleason 8-10: do all men do poorly? results from the search database.

To determine whether there are subsets of men with pathologic high-grade disease (Gleason 8-10) who have particularly high or low 2-year BCR risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathologic features such as surgical margins (SM), extracapsular extension (ECE) and seminal vesicle invasion (SVI).

We identified 459 patients treated with RP with pathologic Gleason 8-10 in the SEARCH database. Patients were stratified into 5 groups based on pathological characteristics - Group 1: men with negative surgical margins and no extracapsular extension (-SM/-ECE), Group 2 (+SM/-ECE), Group 3 (-SM/+ECE), Group 4 (+SM/+ECE), and Group 5: men with SVI (+SVI). Cox proportional hazards models and the log-rank test were used to compare BCR among the groups.

At 2-years post-RP, pathological group was significantly correlated with BCR (log-rank, p

In patients with high grade (Gleason 8-10) prostate cancer after RP, the presence of either positive SM, ECE, or SVI are all associated with an increased risk of early BCR with 2-year BCR risk of 50% or higher. On the contrary, men with organ-confined margin-negative disease have a very low risk of early BCR despite Gleason 8-10 disease. This article is protected by copyright. All rights reserved.

BJU international. 2015 Sep 09 [Epub ahead of print]

Sean Fischer, Daniel Lin, Ross M Simon, Lauren Howard, William J Aronson, Martha K Terris, Christopher J Kane, Christopher L Amling, Matt R Cooperberg, Stephen J Freedland, Adriana C Vidal

Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC. , Department of Urology, University of Washington, Seattle, WA. , Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC. , Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC. , Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles. , Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, Georgia. , Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, California. , Department of Urology, Oregon Health and Science University, Portland, Oregon. , Department of Urology, University of California at San Francisco, San Francisco, California. , Urology Section, Veterans Affairs Medical Center, Durham, NC. , Urology Section, Veterans Affairs Medical Center, Durham, NC.

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