Do all men with pathological Gleason score 8-10 prostate cancer have poor outcomes? Results from the SEARCH database.
To determine whether there are subsets of men with pathological high grade prostate cancer (Gleason score 8-10) with particularly high or low 2-year biochemical recurrence (BCR) risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathological features, such as surgical margin status, extracapsular extension (ECE) and seminal vesicle invasion (SVI).



We identified 459 men treated with RP with pathological Gleason score 8-10 prostate cancer in the SEARCH database. The men were stratified into five groups based on pathological characteristics: group 1, men with negative surgical margins (NSMs) and no ECE; group 2, men with positive surgical margin (PSMs) and no ECE; group 3, men with NSMs and ECE; group 4, men with PSMs and ECE; and group 5, men with SVI. Cox proportional hazards models and the log-rank test were used to compare BCR among the groups.



At 2 years after RP, pathological group was significantly correlated with BCR (log-rank, P < 0.001) with patients in group 5 (+SVI) having the highest BCR risk (66%) and those in group 1 (NSMs and no ECE) having the lowest risk (14%). When we compared groups 2, 3, and 4, with each other, there was no significant difference in BCR among the groups (~50% 2-year BCR risk; log-rank P = 0.28). Results were similar when adjusting for prostate-specific antigen, age, pathological Gleason sum and clinical stage, or after excluding men who received adjuvant therapy.



In patients with high grade (Gleason score 8-10) prostate cancer after RP, the presence of either PSMs, ECE or SVI was associated with an increased risk of early BCR, with a 2-year BCR risk of ≥50%. Conversely, men with organ-confined margin-negative disease had a very low risk of early BCR despite Gleason score 8-10 disease.
Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.|Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.
Sean
S
Fischer
Department of Urology, University of Washington, Seattle, WA, USA.
Daniel
D
Lin
Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.|Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.
Ross M
RM
Simon
Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.|Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
Lauren E
LE
Howard
Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA, USA.|Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA.
William J
WJ
Aronson
Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA, USA.|Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
Martha K
MK
Terris
Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA.
Christopher J
CJ
Kane
Department of Urology, Oregon Health and Science University, Portland, OR, USA.
Christopher L
CL
Amling
Department of Urology, University of California at San Francisco, San Francisco, CA, USA.|Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.|Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA.
Matt R
MR
Cooperberg
Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.|Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Stephen J
SJ
Freedland
Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.|Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Adriana C
AC
Vidal
D000368:Aged; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
Gleason score 8-10; biochemical recurrence; extracapsular extension; positive surgical margin; prostatic neoplasm; seminal vesicle invasion