MP4-17 PATHOLOGIC GLEASON 8-10: DO ALL MEN DO POORLY? RESULTS FROM THE SEARCH DATABASE

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2015MP4-17 PATHOLOGIC GLEASON 8-10: DO ALL MEN DO POORLY? RESULTS FROM THE SEARCH DATABASE Sean Fischer, Ross Simon, Lauren Howard, William Aronson, Martha Terris, Christopher Kane, Christopher Amling, Matt Cooperberg, Stephen Freedland, and Adriana Vidal Sean FischerSean Fischer More articles by this author , Ross SimonRoss Simon More articles by this author , Lauren HowardLauren Howard More articles by this author , William AronsonWilliam Aronson More articles by this author , Martha TerrisMartha Terris More articles by this author , Christopher KaneChristopher Kane More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Matt CooperbergMatt Cooperberg More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , and Adriana VidalAdriana Vidal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pathologic Gleason 8–10 is associated with high risk of biochemical recurrence (BCR). However, whether there are subsets of men with Gleason 8–10 who have particularly high or low BCR risk is unknown. We examined predictors for early BCR (2-years) after radical prostatectomy (RP), among patients with pathological Gleason 8–10. METHODS We identified 459 patients treated with RP with pathologic Gleason 8–10 in the SEARCH database. Patients were stratified into 5 groups based on pathological characteristics – Group 1: men with negative surgical margins and no extracapsular extension (-SM/-ECE), Group 2 (+SM/-ECE), Group 3 (-SM/+ECE), Group 4 (+SM/+ECE), and Group 5: men with seminal vesicle invasion (+SVI). BCR was defined as a single PSA greater than 0.2 ng/ml, 2 values of 0.2 ng/ml, or secondary treatment for an elevated postoperative PSA. Cox proportional hazard models were used to compare early BCR (2-years post-RP) among groups and a log-rank test was used to assess the difference between survival curves by group. RESULTS At 2-years post-RP, patients in Group 5 (+SVI) had the highest BCR risk (66%) whereas men in Group 1 (-SM/-ECE) had the lowest risk (14%, p<0.001). No significant difference in recurrence among groups 2 to 4 (∼50% recurrence, log-rank, p=0.28) was found. On multivariable analysis after adjusting for PSA, age, pathological Gleason sum, and clinical stage; Group 5 had the highest recurrence risk, Groups 2–4 were at intermediate-risk with no differences among the groups, and Group 1 had the lowest risk of recurrence. CONCLUSIONS In patients with high grade (Gleason 8–10) prostate cancer after RP, the presence of surgical margins, extracapsular extension, both surgical margins and extracapsular extension, and seminal vesicle invasion are all associated with an increased risk of early BCR. While patients with seminal vesicle invasion are at the highest risk of recurrence, the presence of any of these pathological features among patients with Gleason 8–10 may warrant adjuvant radiation. On the contrary, men with organ-confined margin negative disease have a very low risk of early BCR despite Gleason 8–10 disease. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e33 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Fischer More articles by this author Ross Simon More articles by this author Lauren Howard More articles by this author William Aronson More articles by this author Martha Terris More articles by this author Christopher Kane More articles by this author Christopher Amling More articles by this author Matt Cooperberg More articles by this author Stephen Freedland More articles by this author Adriana Vidal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...