Natural History of Pathologically Organ-Confined (pT2), Gleason Score 6 or Less, Prostate Cancer After Radical Prostatectomy

Abstract

Objectives-Men with pathologically organ-confined (OC), Gleason score ≤6 prostate cancer (PCa) are considered to have an excellent prognosis following surgery as definitive monotherapy. We determined the incidence of biochemical recurrence (BR), local recurrence (LR), distant metastasis (DM) and prostate-cancer specific mortality (PCSM) among this low-risk cohort.Methods-A retrospective search of our radical prostatectomy database identified 6,081 men with pathologically OC (pT2), Gleason score ≤6 PCa treated between 1983 and 2005. Of these, 2,551 (42%) had adequate follow-up information and were assessed for BR, LR, DM, and PCSM. Pathologic specimens of men who progressed were re-evaluated by an experienced genitourinary pathologist, and patients who were upgraded or upstaged (25) were excluded from further analysis resulting in a final study cohort of 2,526. Actuarial probabilities of BR and LR were estimated using the Kaplan-Meier method.Results-With a median follow-up of 5.0 years (range 2-22), BR occurred in 13 patients (0.5%). The 5-, 10-and 15-year actuarial probabilities of BR were 0.3%, 0.9%, and 1.3%, respectively. Five patients (0.2%) developed LR, four of whom received salvage radiotherapy with subsequently undetectable PSA. The 5-, 10-, and 15-year actuarial probabilities of LR were 0.1%, 0.5%, and 0.5%, respectively. There were no DMs and no PCSMs.Conclusions-With postoperative follow-up on over 2,500 patients with pathologically OC, Gleason score ≤6 PCa, BR and LR following RP were extremely rare and no patients experienced DM or PCSM.

Concordance between transrectal ultrasound guided biopsy results and radical prostatectomy final pathology: Are we getting better at predicting final pathology?

“…12 The migration of higher risk GS6 patients to GS7 would artificially improve the prognosis of GS6, according to the Will Rogers phenomenon. 14 We demonstrated that GS6/6 cancers have better clinical and pathological characteristics than GS6/7 upgrades. With less severe GS6 cancers being graded under the 2005 GS classification, an associated decrease in undergraded cancers and discordance were observed.…”

Maximum tumor diameter: a simple independent predictor for biochemical recurrence after radical prostatectomy

“…1,2 Previous studies have shown the relationship of BCR with several clinical parameters, including pre-operative PSA level, pathological stage, Gleason's score and surgical margin positivity. 3,4 Total tumor volume (TTV) is another potential useful predictor of BCR. Some studies have shown that TTV is an independent predictor for BCR.…”

Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

“…6 Whereas patients with modified Gleason score 6 on radical prostatectomy represent a group with excellent outcome, patients with Gleason score 7 demonstrate a wide range in clinical outcome. [7][8][9] Risk stratification within the Gleason score 7 patient population remains a challenge, and additional prognostic factors are needed. The objective of this study was to determine the predictive value of distinctive Gleason grade 4 growth patterns for metastasis and disease-specific death in men with Gleason score 7 prostate cancer on radical prostatectomy.…”