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Keywords:

  • prostate cancer;
  • high Gleason score;
  • cancer-specific survival;
  • radical prostatectomy

What's known on the subject? and What does the study add?

  • To date, only a few studies have addressed the long-term oncological outcomes of radical prostatectomy (RP) in patients with pathological Gleason score ≥ 8 prostate cancer. According to these reports, some individuals with pathological Gleason score ≥ 8 may benefit from RP, with cancer-control outcomes comparable with those of patients with low- and intermediate-risk prostate cancer.
  • The presence of pathological Gleason score 8–10 represents a poor prognostic factor in the outcome of men with prostate cancer. However, in patients with specimen-confined disease, RP and bilateral PLND provided long-term cancer-control outcomes similar to those of patients with more favourable disease characteristics.

Objectives

  • To evaluate the outcomes of patients with pathological Gleason score 8–10 prostate cancer subjected to radical prostatectomy (RP).
  • To determine the prognostic factors associated with cancer-specific survival (CSS) in this subset of patients.

Patients and Methods

  • The study included 580 consecutive patients with pathological Gleason sum 8–10 prostate cancer treated with RP and pelvic lymph node dissection (PLND) at a single European institution between July 1988 and April 2010. All patients had detailed pathological and follow-up data.
  • Pathological Gleason score was determined by a single expert genitourinary pathologist. Biochemical recurrence (BCR) was defined PSA concentration of ≥0.2 ng/mL and rising.
  • Kaplan–Meier plots were used to graphically explore BCR-free survival as well as CSS and overall survival (OS) rates. Moreover, univariable and multivariable Cox regression models were fitted to test the predictors of CSS.

Results

  • The mean (median, range) age at surgery was 66.1 (66.4, 41–85) years. The mean (median, range) total PSA concentration was 29.6 (11.1, 0.5–1710) ng/mL.
  • Pathological Gleason score was 8 in 238 (41.0%), 9 in 330 (56.9%) and 10 in 12 (2.1%) patients. Overall, 119 (20.5%), 124 (21.4%), 281 (48.4%) and 56 (9.7%) patients had pT2, pT3a, pT3b and pT4 prostate cancer, respectively. Overall, 275 (47.4%) had LN invasion, while 150 (25.1%) patients had specimen-confined disease (defined as pT2cR0 pN0 or pT3aR0 pN0 prostate cancer).
  • The mean (median, range) follow-up was 53 (47, 1–226) months. At 5 and 10 years after RP, BCR-free survival was 76.7% and 49.6%, respectively. Similarly, the 5- and 10-year CSS rates were 87.3% and 69.5%, respectively.
  • Patients with specimen-confined disease (P < 0.001) and patients with negative LNs (P = 0.012) had significantly better CSS rates than their counterparts with less favourable pathological characteristics. In multivariable Cox regression models, only the presence of specimen-confined disease achieved independent predictor status (P = 0.001).

Conclusion

  • Presence of high Gleason score at RP represents a poor prognostic factor in the outcome of patients with prostate cancer.
  • However, RP provides excellent long-term cancer control outcomes in the subset of patients with specimen-confined disease.