title: Biochemical recurrence in Gleason score 7 prostate cancer in korean men: significance of the primary Gleason grade.
abstract: OBJECTIVE
  To evaluate the impact of primary Gleason grade in Gleason score (GS) 7 prostate cancer on biochemical recurrence (BCR) after radical prostatectomy in Korean men.
  
  
  METHODS
  We retrospectively reviewed records of 1,026 patients who underwent radical prostatectomy at Seoul National University Bundang Hospital between November 2003 and June 2009. We excluded patients who had received neoadjuvant therapy and had positive resection margins. Finally, 295 and 113 patients with GS 3+4 and GS 4+3, respectively, were included in this study. All patients were followed for at least 2 years.
  
  
  RESULTS
  Of the 408 GS 7 patients, 295 (72.3%) were 3+4 and 113 (27.7%) were 4+3. Mean serum prostate specific antigen level in primary Gleason 3 was 8.99 ng/ml and primary Gleason 4 was 11.11 ng/ml. Patients with GS 4+3 were more likely to have extracapsular extension (30.1% vs. 17.6%, p<0.010) and lymphatic invasion (16.8% vs. 7.1%, p<0.005). After 2 years follow up BCR was detected in a total of 40 patients. In GS 7 with primary Gleason 3, BCR occurred in 15 (5.08%) patients while 20 (17.70%) showed BCR in GS 7 with primary Gleason 4.
  
  
  CONCLUSIONS
  In this study of a large, single center cohort of Korean men with GS 7 prostate cancer a noticeable difference in BCR was seen. Primary Gleason grade 4 have a higher risk of BCR compared to primary Gleason grade 3. This information may be useful when counseling patients on their prognosis and further management options.
authors.affiliation: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yun Kwan
authors.initials: YK
authors.lastname: Ro
authors.forename: Sangchul
authors.initials: S
authors.lastname: Lee
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.forename: Seok Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
keywords: Biopsy; Prostate; Prostatectomy