title: Disease-specific death and metastasis do not occur in patients with Gleason score ≤6 at radical prostatectomy.
abstract: OBJECTIVE
  To assess the metastasis-free survival (MFS) and disease-specific survival (DSS) in men with Gleason score ≤6 prostate cancer at radical prostatectomy (RP).
  
  
  METHODS
  We included 1101 consecutive RP patients operated between March 1985 to July 2013 at a single institution. The outcome variables were MFS and DSS. The postoperative survival was estimated by the Kaplan-Meier method.
  
  
  RESULTS
  The Gleason score distribution of the study population (1101 patients) was Gleason score ≤6 (449, 41%), Gleason score 3 + 4 = 7 (436, 40%), Gleason score 4 + 3 = 7 (99, 9%) and Gleason score 8-10 (117, 11%). The median (interquartile range) postoperative follow-up was 100 (48-150) months. During follow-up 197 men (18%) died, of whom 42 (3.8%) died from prostate cancer-related causes. In all, 19/1101 patients (1.7%) had documented lymph node metastasis at the time of RP: none with Gleason score ≤6, seven with Gleason score 3 + 4 = 7 (1.6%), six with Gleason score 4 + 3 = 7 (6.1%) and six with Gleason score 8-10 (5.1%). Distant metastasis occurred in 56/1101 patients (5.1%): none with Gleason score ≤6, 23 with Gleason score 3 + 4 = 7 (5.3%), 17 with Gleason score 4 + 3 = 7 (17%) and 16 with Gleason score 8-10 (14%). Disease-specific death, stratified per Gleason-score group was: none in ≤6, 16 (3.7%) in 3 + 4 = 7, 16 (16%) in 4 + 3 = 7 and 10 (8.5%) in 8-10 group.
  
  
  CONCLUSIONS
  No metastasis or disease-specific death were seen in men with Gleason score ≤6 prostate cancer at RP, showing the negligible potential to metastasise in this large subgroup of patients with prostate cancer.
authors: Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Charlotte F
authors: CF
authors: Kweldam
authors: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.|Department of Research Office Sophia, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Mark F
authors: MF
authors: Wildhagen
authors: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Chris H
authors: CH
authors: Bangma
authors: Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Geert J L H
authors: GJ
authors: van Leenders
mesh_terms: D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000145:classification / Q000401:mortality* / Q000473:pathology* / Q000601:surgery
keywords: Gleason score; prostate cancer; radical prostatectomy; survival