LONG-TERM SURVIVAL AFTER RADICAL PROSTATECTOMY FOR MEN WITH HIGH PATHOLOGIC GLEASON SUM

Abstract

INTRODUCTION AND OBJECTIVE: To evaluate longterm outcomes of patients with high Gleason sum (8-10) at radical prostatectomy (RP) and to identify predictors of prostate cancer-specific survival (CSS) in this cohort. METHODS: The Institutional RP Database was queried. 9,381 patients underwent RP from 1982 to 2008 with complete follow-up; 1,061 patients had pathologic Gleason sum 8-10. Patient and prostate cancer characteristics were evaluated. Survival analyses were performed using Kaplan-Meier method. Univariate and multivariate proportional hazard regression models were created to evaluate pertinent predictors of CSS (death from or attributed to prostate cancer). RESULTS: Median pre-operative PSA was 7.6 ng/mL; 435 men had clinical stage T1 tumor, 568 had T2. Biopsy Gleason sum was 7 in 239, 399 and 398 patients, respectively. Median follow-up was five years (range 1-23 years). Actuarial 15-year recurrence-free survival, CSS and overall survival rates were 20.7%, 57.4% and 45.4%, respectively. In multivariate analysis, predictors of poor CSS were biopsy Gleason sum of 8 or greater, pathological Gleason sum of 9-10, seminal vesical and lymph node involvement. Patients with pathological Gleason sum 8 and organ confined disease experienced a CSS of 89.9% at 15 years. CONCLUSIONS: 80% of men with Gleason sum 8-10 who undergo RP will experience biochemical recurrence at 15 years. However, CSS approached 90% in men with pathologic organ-confined disease. Higher pathological Gleason sum (9-10), seminal vesical and lymph node involvement are independent predictors of worse CSS.