title: The outcome of patients with pathological Gleason score >or=8 prostate cancer after radical prostatectomy.
abstract: OBJECTIVE
  To analyse the outcome of patients undergoing radical prostatectomy (RP) for Gleason 8-10 clinically localized prostate cancer, and to evaluate the prognostic value of well-known predictors of progression.
  
  
  METHODS
  In all, 1480 patients had RP between 1988 and 2006, of whom 180 had pathological Gleason score >or=8 and negative lymph nodes. Biochemical progression-free survival was determined using the Kaplan-Meier method. The effect of preoperative prostate-specific antigen (PSA) level, pathological stage and margin status was assessed with univariate and multivariate analyses.
  
  
  RESULTS
  Of the 180 patients, the Gleason score in the RP specimen was 8, 9 or 10 in 70%, 27% and 3%, respectively; 24% had stage pT2 disease, 30% stage pT3a, 25% stage pT3b and 20% stage pT4a. The 5- and 7-year biochemical progression-free survival was 73 and 65% for stage pT2, 40% and 27% for stage pT3a, and 30% for stage pT3b (log rank test, P < 0.001). In the univariate model, preoperative PSA level, pathological stage and surgical margins were predictors of survival. In the multivariate analysis, preoperative PSA level and extracapsular extension predicted biochemical progression-free survival.
  
  
  CONCLUSIONS
  Gleason 8-10 tumours have a poor prognosis. Patients with a PSA level of <10 ng/mL and stage pT2 disease have the greatest likelihood of having a longer progression-free survival after RP.
authors.affiliation: Department of Urology, Henri Mondor Universtity Hospital, Créteil, France. ftrc5@hotmail.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez-Covarrubias
authors.forename: Stephane
authors.initials: S
authors.lastname: Larre
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: Claude-Clement
authors.initials: CC
authors.lastname: Abbou
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen