MP79-13 TESTOSTERONE LEVELS AS A PREDICTOR FACTOR OF AGRESSIVE DISEASE IN PATIENTS WITH PROSTATE CANCER SUBMITTED TO RADICAL PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: We sought to determine the prognostic value of percentage Gleason pattern 4 in radical prostatectomy specimens. METHODS: We selected 400 patients who underwent robotic radical prostatectomy (RRP) between 2010 and 2011 with Gleason score 7. Data collected included pT stage, tumor volume, margin status, angiolymphatic invasion, lymph node involvement and biochemical recurrence (BCR) at 2 years after surgery. RESULTS: Mean age of the patients was 62 years. We stratified the patients into four quartiles based on percentage of Gleason pattern 4 (GP4). Q1: percent of Gleason 4 20% 35%, Q3: >35% 65%, Q4: >65%. Table 1 shows these quartiles correlated with multiple pathological outcomes. Percentage of GP4 was associated with BCR when other pathologic features were accounted for. A percent greater than 65 (i.e. fourth quartile) was significantly different from a percent of 20 or less in providing a greater likelihood for recurrence OR1⁄46.53 (95% CI 2.43, 17.56). The other factors that were also significant were margins, positive lymph nodes and angiolymphatic invasion. These four variables yielded a c-statistic of 0.82. If percentage of GP4 is considered as a continuous measure, it is also independently related with PSA recurrence within 2 years of surgery. A unit increase in the percent of GP4 increases the likelihood of recurrence by 3 percent, OR1⁄41.03 (1.01, 1.04). CONCLUSIONS: 1. Gleason 7 prostatic adenocarcinoma represents a heterogenous group of tumors. A subgroup of tumors with Gleason score 3+41⁄47 and low percentage of GP4 ( 20%) of pattern 4. 2. Percentage of GP4 is an important parameter that should be reported on all radical prostatectomies with Gleason score 7, given its independent prognostic value. 3. Additional studies are needed to determine the role of higher Gleason pattern percentages in tumors other than Gleason score 7. Source of Funding: None