Long-term outcome in patients with a Gleason score ≤ 6 prostate cancer treated by radical prostatectomy.

Birkhahn M, Penson DF, Cai J, Groshen S, Stein JP, Lieskovsky G, Skinner DG, Cote RJ
BJU Int. 2011 108 (5): 660-4

PMID: 21223479 · DOI:10.1111/j.1464-410X.2010.09978.x

OBJECTIVE - • 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.

PATIENTS AND METHODS - • 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.

RESULTS - • 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.

CONCLUSION - • 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.


MeSH Terms (18)

Adult Aged Aged, 80 and over Biopsy, Needle Disease-Free Survival Follow-Up Studies Humans Lymph Node Excision Male Middle Aged Neoplasm Recurrence, Local Neoplasm Staging Prognosis Prostatectomy Prostatic Neoplasms Risk Factors Time Factors Treatment Outcome

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