Effect of Age and Pathologic Gleason Score on PSA Recurrence: Analysis of 2911 Patients Undergoing Radical Prostatectomy

Abstract

To clarify the relationship between age and pathologic Gleason score and their effect on prostate-specific antigen recurrence (PSAR). The data from a cohort of 2911 men who had undergone radical prostatectomy from 1988 to 2006 were retrieved from the Duke Prostate Center database. Patient age was divided into 3 groups: <60, 60-64, and >or=65 years. The pathologic Gleason score was divided into 5 groups: <or=5, 6, 3 + 4, 4 + 3, and >7. PSAR was defined as the prostate-specific antigen level increasing to >0.2 ng/mL >30 days after radical prostatectomy. The associations between age and pathologic Gleason score on PSAR and the time to PSAR were analyzed using parametric, nonparametric, Kaplan-Meier, and Cox regression techniques. Patient age and interval to PSAR had no significant association (P > .05). Kaplan-Meier analysis demonstrated a significant difference in PSAR among age groups. The pathologic Gleason scores of 3 + 3, 3 + 4, 4 + 3, and >7 were significant in determining the incidence of PSAR. Age was not significant for PSAR in patients with a pathologic Gleason score of <or=7. In patients with a pathologic Gleason score of >7, a statistically significant difference was observed among the age groups. Men <60 years old with a pathologic Gleason score >7 had a lower incidence of PSAR than did older men with a similar pathologic Gleason score. A pathologic Gleason score of >or=6 was significant in predicting PSAR. Age alone was an independent factor in predicting PSAR, but not in predicting the interval to PSAR. The pathologic Gleason score remained a predictor of PSAR, and patient age should be considered in patients with a pathologic Gleason score >7.