title: Long-term outcome in patients with a Gleason score ≤ 6 prostate cancer treated by radical prostatectomy.
abstract: OBJECTIVE
  • To determine the actual recurrence risk of patients with a Gleason score (GS) ≤ 6 treated with radical retropubic prostatectomy (RRP) and bilateral lymphadenectomy in a cohort with long-term follow-up.
  
  
  METHODS
  • The USC/Norris Comprehensive Cancer Center database included 3235 consecutive patients who underwent RRP for prostate cancer between January 1972 and December 2005. We identified 1383 patients with a GS ≤ 6 in prostatectomy specimens. Median follow-up was 8.3 years. Data on pathological and clinical characteristics and outcome were prospectively recorded. • Statistical analysis was performed using the stratified log-rank test and stepwise Cox regression analysis.
  
  
  RESULTS
  • A GS of 6 was present in 66%, 5 in 27%, 4 in 5% and 3 or 2 in 3% of cases. Tumour classification was pT2N0 (83%), pT3N0 (14%), pT4N0 (0.1%) and any TN1 (2%). • Positive margins were seen in 18%. Estimated PSA and clinical recurrence rate were 14% and 4% after 10 years and 18% and 6% after 15 years, respectively. In multivariate analysis, N-stage (P < 0.001), T-stage (P= 0.02) and margin status (P < 0.001) were associated with PSA recurrence. • N-stage (P < 0.001) and T-stage (P= 0.01) were associated with clinical recurrence. • Overall, patients with a GS ≤ 6 accounted for 26% of all PSA recurrences and for 20% of all patients with clinical recurrences in the database.
  
  
  CONCLUSIONS
  • A relatively small proportion of patients with a GS ≤ 6 cancer developed PSA recurrence and/or overt metastasis. However, these patients account for a substantial minority of those who experienced recurrence and metastasis.
authors.affiliation: Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Birkhahn
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Susan
authors.initials: S
authors.lastname: Groshen
authors.forename: John P
authors.initials: JP
authors.lastname: Stein
authors.forename: Gary
authors.initials: G
authors.lastname: Lieskovsky
authors.forename: Donald G
authors.initials: DG
authors.lastname: Skinner
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cote
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome