High-Grade Prostate Cancer Has a Poor Prognosis
BJU Int. 2008;101:305-307
Patients with Gleason 8-10 prostate tumors have a poor prognosis, according to researchers at the
In addition, patients with a preoperative PSA level below 10 ng/mL and stage pT2 disease have the greatest likelihood of having a longer biochemical progression-free survival (bPFS) following radical prostatectomy (RP).
The researchers, led by Francisco Rodriguez-Covarrubias, MD, retrospectively studied 180 men with pathological Gleason scores of 8 or higher and negative lymph nodes. The Gleason score was 8, 9, or 10 in 70%, 27%, and 3% of RP specimens, respectively; 24% had stage pT2 disease, 30% had stage pT3a disease, 25% had stage pT3b disease, and 20% had stage pT4a disease.
The five- and seven-year bPFS for the 180 men was 40% and 35%, respectively. It was 73% and 65% for stage pT2 disease, respectively, and 40% and 27% for stage pT3a disease. It was 30% for stage pT3b disease. Patients with a preoperative PSA above 10 ng/mL were twice as likely to experience biochemical failure as men with lower preoperative PSA levels. Patients with extracapsular extension (ECE) had a threefold greater risk of biochemical failure than patients without ECE.
“Our results suggest that surgery alone is a useful tool in the initial management of high-grade prostate cancer,” the investigators wrote. “Although RP alone seems to provide an adequate local conrol of the disease, the role of immediate adjuvant therapy in the long-term survival of this subset of patients should be evaluated in a prospective study.”