Outcome after radical prostatectomy with a pretreatment prostate biopsy Gleason score of ≥8

Manoharan, M.; Bird, Vincent G.; Kim, S.S.; Civantos, Francisco; Soloway, Mark S.

doi:10.1046/j.1464-410x.2003.04419.x

Cited by 59 publications

(50 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, it should be noted that the incidence of organ-confined disease of 21% to 41% in the current study closely mirrors the 30% noted in a previous report of men with biopsy Gleason sum 8 to 10 tumors. 4 The overall 5-year and 10-year PSA-free survival was 40% and 27% in the Johns Hopkins patients, respectively, and was nearly identical to the SEARCH cohort (32% and 28%, respectively). Moreover, these numbers are very similar to the 38% 5-year PSA-free survival risk among men with a biopsy Gleason sum 8 to 10 tumors and a PSA level <20 ng/mL who are treated with radical prostatectomy in the communitybased CaPSURE Database.…”

Section: Discussionmentioning

confidence: 73%

“…2 In recent series of patients treated by surgical monotherapy, approximately 4% to 12% of patients had a biopsy Gleason sum 8. [3][4][5][6][7] Given the migration to a lower stage of disease at presentation, these patients may theoretically be appropriate candidates for local therapy alone if diagnosed early in the disease process. 8 The goal of pretreatment evaluation in patients with Gleason sums 8 to 10 should be to identify those who would benefit most from local therapy and those who should be considered for early systemic therapy.…”

Section: Resultsmentioning

confidence: 99%

“…Despite this increased risk for adverse outcomes, it is not uncommon that these men are treated with surgical monotherapy and they account for 4% to 12% of all patients undergoing radical prostatectomy in contemporary series. [3][4][5][6][7] Several studies have examined outcomes among men with a Gleason sum of 8 tumor in the radical prostatectomy specimen and found that overall outcomes are poor. 3,8,[16][17][18][19] However, it is not always possible to identify men with high-grade disease in the radical prostatectomy specimen before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This degree of overgrading for men with a biopsy Gleason sum 8-10 cancer has been noted previously. 4 However, even among men who were downgraded (i.e., pathologic Gleason sum <8), outcomes were poor, with the majority of patients experiencing biochemical disease progression. Thus, despite either favorable pathologic findings or lower-grade disease in the radical prostatectomy specimen, men with high-grade disease on biopsy should be viewed as high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10

Bastian

Gonzalgo

Aronson

et al. 2006

Cancer

View full text Add to dashboard Cite

BACKGROUND Men with a biopsy Gleason sum of 8 to 10 are considered high‐risk. The current study sought to identify whether there was a subset of men with high biopsy Gleason sums who would have a good pathologic and biochemical outcome with surgical monotherapy. To increase the generalizability of the findings, data were used from patients treated at 2 very different practice settings: a tertiary care referral center (Johns Hopkins Hospital) and multiple equal‐access medical centers (Shared Equal Access Regional Cancer Hospital [SEARCH] Database). METHODS The data were retrospectively reviewed from men with biopsy Gleason sums 8 to 10 treated by radical prostatectomy at the Johns Hopkins Hospital (n = 220, 3.8% of total cohort) and within the SEARCH Database (n = 149, 7.7% of total cohort). The preoperative clinical characteristics predicting unfavorable pathologic disease (nonorgan‐confined and/or positive surgical margins) and time to biochemical recurrence were determined using logistic regression and Cox proportional hazards analysis, respectively. RESULTS Favorable pathologic outcome (organ‐confined and negative surgical margins) was observed in 21% of the men in the Johns Hopkins cohort and 41% from the SEARCH cohort. On multivariate analysis, higher serum prostate‐specific antigen (PSA) was the only variable that significantly predicted an unfavorable pathologic outcome from both the Johns Hopkins (P = .047) and SEARCH cohorts (P = .002). The 5‐year and 10‐year estimated biochemical‐free survival rates in the Johns Hopkins cohort were 40% (95% confidence interval [CI], 33–48%) and 27% (95% CI, 18–36%), respectively, and 32% (95% CI, 22–42%) and 28% (95% CI, 18–38%) in the SEARCH cohort, respectively. Among men with favorable pathologic findings, the 5‐ and 10‐year estimated biochemical‐free survival rates in the Johns Hopkins cohort were 79% (95% CI, 62–89%) and 50% (95% CI, 25–71%), respectively, and 49% (95% CI, 32–65%) and 49% (95% CI, 32–65%) in the SEARCH cohort, respectively. No single preoperative variable significantly predicted the risk of biochemical progression in both the SEARCH or Johns Hopkins cohorts. CONCLUSIONS The majority of men with a biopsy Gleason sum of ≥8, regardless of where the patient is treated, had unfavorable pathologic disease and experienced a biochemical progression after radical prostatectomy. Even among men with organ‐confined disease and negative surgical margins or pathologic Gleason sum <8, at least half of the men experienced a PSA recurrence. Patients with biopsy Gleason sum 8 to 10 cancers are good candidates for multimodal therapy. Whereas multimodal therapy has often meant radiation plus hormonal therapy, newer possibilities for multimodal therapy exist such as surgery with neoadjuvant or adjuvant chemohormonal therapy or surgery with adjuvant radiation. Cancer 2006. © 2006 American Cancer Society.

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10

Bastian

Gonzalgo

Aronson

et al. 2006

Cancer

View full text Add to dashboard Cite

show abstract

“…Several large-scale studies have evaluated PSA and GS as prognostic indicators in men with potentially curable prostate cancer. [3][4][5][6] However, the results from studies on PSA and survival must be interpreted in the context of the population from which they were obtained. Whereas both organized and opportunistic screening and curative treatment are practiced widely in North America, screening and management of prostate cancer in Sweden is more conservative, and fewer asymptomatic tumors are revealed by opportunistic screening or as part of a planned screening program.…”

mentioning

confidence: 99%

The impact of prostate‐specific antigen level at diagnosis on the relative survival of 28,531 men with localized carcinoma of the prostate

Sandblom

Ladjevardi

Garmo

et al. 2008

Cancer

View full text Add to dashboard Cite

BACKGROUND. To evaluate the predictive value of prostate‐specific antigen (PSA) in a population‐based cohort, the authors analyzed relative survival in all men with localized prostate cancer who were registered in the Swedish National Prostate Cancer Register (NPCR) from 1996 to 2005. METHODS. All men aged <75 years with localized tumors were identified in the NPCR. A Poisson regression analysis was performed using observed death as response and the expected death rate as offset. The expected and observed numbers of survivors were calculated with stratification for PSA level and 3 categories of tumor differentiation (Gleason score 2–6, 7, and 8–10). The regression model included PSA as linear splines with a breakpoint at a PSA level of 4 ng/mL and with tumor differentiation as a categoric variable. RESULTS. The Poisson regression analysis indicated a U‐shaped curve for all 3 groups, with a negative correlation between PSA and relative survival in men with PSA levels <4 ng/mL and a positive correlation for men with PSA levels >4 ng/mL. The correlation was significant for all 3 groups, but the negative correlation between PSA and relative survival was significantly more pronounced in the group with Gleason scores from 8 to 10 than in the other 2 Gleason score groups. CONCLUSIONS. The demonstration of an inverse correlation between PSA level and relative survival in the group of men with PSA levels <4 ng/mL indicated the presence of a small but clinically important subgroup with undifferentiated tumors who have cells that have lost the ability to secrete PSA. This group should be taken into consideration when deciding on treatment and when choosing a cutoff level in PSA screening programs. Cancer 2008. © 2007 American Cancer Society.

show abstract

The Role for Radical Prostatectomy in Advanced Prostate Cancer

Karnes

Blute

2012

Management of Prostate Cancer

View full text Add to dashboard Cite

Outcome after radical prostatectomy with a pretreatment prostate biopsy Gleason score of ≥8

Cited by 59 publications

References 38 publications

Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10

Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10

The impact of prostate‐specific antigen level at diagnosis on the relative survival of 28,531 men with localized carcinoma of the prostate

The Role for Radical Prostatectomy in Advanced Prostate Cancer

Contact Info

Product

Resources

About