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. 2010 Sep;76(3):715-21.
doi: 10.1016/j.urology.2009.11.085. Epub 2010 Mar 29.

Long-term survival after radical prostatectomy for men with high Gleason sum in pathologic specimen

Phillip M Pierorazio  1 , Thomas J Guzzo, Misop Han, Trinity J Bivalacqua, Jonathan I Epstein, Edward M Schaeffer, Mark Schoenberg, Patrick C Walsh, Alan W Partin
Affiliations

Long-term survival after radical prostatectomy for men with high Gleason sum in pathologic specimen

Phillip M Pierorazio et al. Urology. 2010 Sep.

Abstract

Objectives: To evaluate the long-term outcomes of patients with high Gleason sum 8-10 at radical prostatectomy (RP) and to identify the predictors of prostate cancer-specific survival (CSS) in this cohort.

Methods: The institutional RP database was queried. A total of 9381 patients with complete follow-up underwent RP from 1982 to 2008. Of these 9381 patients, 1061 had pathologic Gleason sum 8-10 cancer. The patient and prostate cancer characteristics were evaluated. Survival analyses were performed using the Kaplan-Meier method. Univariate and multivariate proportional hazard regression models were created to evaluate the pertinent predictors of CSS (death from, or attributed to, prostate cancer).

Results: The median preoperative prostate-specific antigen level was 7.6 ng/mL; 435 men had clinical Stage T1 tumor, 568 had Stage T2, and 36 had Stage T3. The biopsy Gleason sum was <7, 7, and >7 in 244 (22.3%), 406 (37.2%), and 425 (38.9%) patients, respectively. The median follow-up was 5 years (range 1-23). The actuarial 15-year recurrence-free survival, CSS, and overall survival rate was 20.7%, 57.4%, and 45.4%, respectively. On multivariate analysis, the predictors of poor CSS were pathologic Gleason sum 9-10 and seminal vesicle and lymph node involvement. Patients with pathologic Gleason sum 8 and organ-confined disease had a CSS rate of 89.9% at 15 years.

Conclusions: The results of our study have shown that 80% of the men with Gleason sum 8-10 who undergo RP will have experienced biochemical recurrence by 15 years. However, the CSS rate approached 90% for men with pathologic organ-confined disease. Higher pathologic Gleason sum 9-10 and seminal vesicle and lymph node involvement were independent predictors of worse CSS.

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Figures

Figure 1
Figure 1
Kaplan-Meier actuarial PSA recurrence- free survival, Prostate Cancer-specific Survival and Overall Survival.
See this image and copyright information in PMC

Comment in

  • Editorial comment.
    Catalona WJ. Catalona WJ. Urology. 2010 Sep;76(3):721; discussion 722. doi: 10.1016/j.urology.2010.01.029. Urology. 2010. PMID: 20832636 No abstract available.
  • Editorial comment.
    Tollefson MK, Blute ML. Tollefson MK, et al. Urology. 2010 Sep;76(3):721-2; discussion 722. doi: 10.1016/j.urology.2010.01.028. Urology. 2010. PMID: 20832637 No abstract available.

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