Pathologic Gleason score predicts the risk of biochemical recurrence (BCR) of prostate cancer (PCa) among patients found to have positive surgical margins after radical prostatectomy and who have not received adjuvant or neoadjuvant treatment, a new study finds.
Other features—such as the Gleason score of the positive margin, length of positive margin, prostate volume, perineural invasion, vascular invasion, lymphovascular invasion, nerve-sparing surgery, and age—did not predict BCR.
For the study, investigators led by Alexander Karl, MD, and Alexander Buchner, MD, of Ludwig-Maximilians University in Munich, Germany, reassessed the prostate specimens of 536 radical prostatectomy patients with pT3aN0/NxR1 from 8 centers. None of the patients received adjuvant or neoadjuvant treatment. The researchers evaluated the ability of a variety of clinical and pathological parameters to predict BCR.
According to results published online ahead of print in Radiotherapy and Oncology, BCR occurred in 39.7% of patients over 4 years of follow-up. After multivariable analysis, only Gleason score of the surgical specimen independently predicted BCR. The 5-year BCR-free survival rates were 74%, 70%, 38%, and 51% for Gleason score 6, 7a (3+4), 7b (4+3), and 8-10, respectively. A clear difference in BCR-free survival between Gleason 7a and 7b disease emerged.
Current European Association of Urology guidelines recommend either immediate radiotherapy or monitoring followed by salvage radiotherapy for these particular patients. In light of the study findings, patients who have a lower likelihood of BCR may make better candidates for monitoring. “These findings could help to estimate and discuss the individual risk for BCR with our patients on an individual basis,” the investigators stated.
Limitations of the study include the lack of a comparison group undergoing adjuvant radiation therapy, potentially missing data, and a relatively short follow-up period to assess BCR.