PURPOSE: There is a paucity of data on the prognosis following radical prostatectomy (RP) with Gleason score 9-10 (GS910) on needle biopsy.
The current study is the largest to specifically analyze the correlation of Gleason score 9-10 on needle core biopsy with outcomes at radical prostatectomy.
MATERIAL AND METHODS: We identified 259 men (1987-2012) with GS910 on biopsy that underwent RP at our institution. The following preoperative variables were analyzed: age, race, pre-operative PSA (prePSA), location of adenocarcinoma, perineural invasion, number of total biopsy cores, number of total positive cores, number of positive cores with GS910, maximum percent of core length with GS910 and maximum percent of adenocarcinoma overall. Pathological outcomes (organ confinement [OC], seminal vesicle invasion [SV], margin status [SM], lymph node metastases [LN], biochemical free survival [BFS] and cancer specific survival [CSS]) were analyzed in uni- and multivariate analyses.
RESULTS: Statistically significant predictors of outcome at RP were as follows: OC = total cores with GS910, maximum percent overall and presence of perineural invasion. SM = prePSA level and clinical stage. SV = maximum percent overall, perineural invasion and clinical stage. LN = total number of cores with GS910 and clinical stage. BFS = maximum percent GS910, maximum percent overall and clinical stage (all variables p< 0.05).
CONCLUSIONS: For the highly selected subset of patients who are good surgical candidates and who have the appropriate combination of preoperative variables, post-operative findings are sufficiently favorable to justify radical prostatectomy.
Written by:
Ellis CL, Partin AW, Han M, Epstein JI. Are you the author?
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD.
Reference: J Urol. 2013 May 29. pii: S0022-5347(13)04421-2.
doi: 10.1016/j.juro.2013.05.056
PubMed Abstract
PMID: 23727307
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