Long-term outcome in patients with a Gleason score ≤6 prostate cancer treated by radical prostatectomy

Marc Birkhahn, David F. Penson, Jie Cai, Susan Groshen, John P. Stein, Gary Lieskovsky, Donald G. Skinner, Richard J Cote

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE To determine the actual recurrence risk of patients with a Gleason score (GS) ≤6 treated with radical retropubic prostatectomy (RRP) and bilateral lymphadenectomy in a cohort with long-term follow-up. PATIENTS AND METHODS âcent The USC/Norris Comprehensive Cancer Center database included 3235 consecutive patients who underwent RRP for prostate cancer between January 1972 and December 2005. We identified 1383 patients with a GS a;circ 6 in prostatectomy specimens. Median follow-up was 8.3 years. Data on pathological and clinical characteristics and outcome were prospectively recorded. Statistical analysis was performed using the stratified log-rank test and stepwise Cox regression analysis. RESULTS A GS of 6 was present in 66%, 5 in 27%, 4 in 5% and 3 or 2 in 3% of cases. Tumour classification was pT2N0 (83%), pT3N0 (14%), pT4N0 (0.1%) and any TN1 (2%). Positive margins were seen in 18%. Estimated PSA and clinical recurrence rate were 14% and 4% after 10 years and 18% and 6% after 15 years, respectively. In multivariate analysis, N-stage (P < 0.001), T-stage (P= 0.02) and margin status (P < 0.001) were associated with PSA recurrence. N-stage (P < 0.001) and T-stage (P= 0.01) were associated with clinical recurrence. Overall, patients with a GS ≤ 6 accounted for 26% of all PSA recurrences and for 20% of all patients with clinical recurrences in the database. CONCLUSION âcent A relatively small proportion of patients with a GS a;circ 6 cancer developed PSA recurrence and/or overt metastasis. However, these patients account for a substantial minority of those who experienced recurrence and metastasis.

Original languageEnglish
Pages (from-to)660-664
Number of pages5
JournalBJU International
Volume108
Issue number5
DOIs
StatePublished - Sep 1 2011

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Neoplasm Grading
Prostatectomy
Prostatic Neoplasms
Recurrence
Databases
Neoplasm Metastasis
Neoplasms
Lymph Node Excision
Multivariate Analysis
Regression Analysis

Keywords

  • Gleason score ≤6
  • metastasis
  • prognosis
  • prostate cancer
  • risk factors

ASJC Scopus subject areas

  • Urology

Cite this

Long-term outcome in patients with a Gleason score ≤6 prostate cancer treated by radical prostatectomy. / Birkhahn, Marc; Penson, David F.; Cai, Jie; Groshen, Susan; Stein, John P.; Lieskovsky, Gary; Skinner, Donald G.; Cote, Richard J.

In: BJU International, Vol. 108, No. 5, 01.09.2011, p. 660-664.

Research output: Contribution to journalArticle

Birkhahn, M, Penson, DF, Cai, J, Groshen, S, Stein, JP, Lieskovsky, G, Skinner, DG & Cote, RJ 2011, 'Long-term outcome in patients with a Gleason score ≤6 prostate cancer treated by radical prostatectomy', BJU International, vol. 108, no. 5, pp. 660-664. https://doi.org/10.1111/j.1464-410X.2010.09978.x
Birkhahn, Marc ; Penson, David F. ; Cai, Jie ; Groshen, Susan ; Stein, John P. ; Lieskovsky, Gary ; Skinner, Donald G. ; Cote, Richard J. / Long-term outcome in patients with a Gleason score ≤6 prostate cancer treated by radical prostatectomy. In: BJU International. 2011 ; Vol. 108, No. 5. pp. 660-664.
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abstract = "OBJECTIVE To determine the actual recurrence risk of patients with a Gleason score (GS) ≤6 treated with radical retropubic prostatectomy (RRP) and bilateral lymphadenectomy in a cohort with long-term follow-up. PATIENTS AND METHODS {\^a}cent The USC/Norris Comprehensive Cancer Center database included 3235 consecutive patients who underwent RRP for prostate cancer between January 1972 and December 2005. We identified 1383 patients with a GS a;circ 6 in prostatectomy specimens. Median follow-up was 8.3 years. Data on pathological and clinical characteristics and outcome were prospectively recorded. Statistical analysis was performed using the stratified log-rank test and stepwise Cox regression analysis. RESULTS A GS of 6 was present in 66{\%}, 5 in 27{\%}, 4 in 5{\%} and 3 or 2 in 3{\%} of cases. Tumour classification was pT2N0 (83{\%}), pT3N0 (14{\%}), pT4N0 (0.1{\%}) and any TN1 (2{\%}). Positive margins were seen in 18{\%}. Estimated PSA and clinical recurrence rate were 14{\%} and 4{\%} after 10 years and 18{\%} and 6{\%} after 15 years, respectively. In multivariate analysis, N-stage (P < 0.001), T-stage (P= 0.02) and margin status (P < 0.001) were associated with PSA recurrence. N-stage (P < 0.001) and T-stage (P= 0.01) were associated with clinical recurrence. Overall, patients with a GS ≤ 6 accounted for 26{\%} of all PSA recurrences and for 20{\%} of all patients with clinical recurrences in the database. CONCLUSION {\^a}cent A relatively small proportion of patients with a GS a;circ 6 cancer developed PSA recurrence and/or overt metastasis. However, these patients account for a substantial minority of those who experienced recurrence and metastasis.",
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T1 - Long-term outcome in patients with a Gleason score ≤6 prostate cancer treated by radical prostatectomy

AU - Birkhahn, Marc

AU - Penson, David F.

AU - Cai, Jie

AU - Groshen, Susan

AU - Stein, John P.

AU - Lieskovsky, Gary

AU - Skinner, Donald G.

AU - Cote, Richard J

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N2 - OBJECTIVE To determine the actual recurrence risk of patients with a Gleason score (GS) ≤6 treated with radical retropubic prostatectomy (RRP) and bilateral lymphadenectomy in a cohort with long-term follow-up. PATIENTS AND METHODS âcent The USC/Norris Comprehensive Cancer Center database included 3235 consecutive patients who underwent RRP for prostate cancer between January 1972 and December 2005. We identified 1383 patients with a GS a;circ 6 in prostatectomy specimens. Median follow-up was 8.3 years. Data on pathological and clinical characteristics and outcome were prospectively recorded. Statistical analysis was performed using the stratified log-rank test and stepwise Cox regression analysis. RESULTS A GS of 6 was present in 66%, 5 in 27%, 4 in 5% and 3 or 2 in 3% of cases. Tumour classification was pT2N0 (83%), pT3N0 (14%), pT4N0 (0.1%) and any TN1 (2%). Positive margins were seen in 18%. Estimated PSA and clinical recurrence rate were 14% and 4% after 10 years and 18% and 6% after 15 years, respectively. In multivariate analysis, N-stage (P < 0.001), T-stage (P= 0.02) and margin status (P < 0.001) were associated with PSA recurrence. N-stage (P < 0.001) and T-stage (P= 0.01) were associated with clinical recurrence. Overall, patients with a GS ≤ 6 accounted for 26% of all PSA recurrences and for 20% of all patients with clinical recurrences in the database. CONCLUSION âcent A relatively small proportion of patients with a GS a;circ 6 cancer developed PSA recurrence and/or overt metastasis. However, these patients account for a substantial minority of those who experienced recurrence and metastasis.

AB - OBJECTIVE To determine the actual recurrence risk of patients with a Gleason score (GS) ≤6 treated with radical retropubic prostatectomy (RRP) and bilateral lymphadenectomy in a cohort with long-term follow-up. PATIENTS AND METHODS âcent The USC/Norris Comprehensive Cancer Center database included 3235 consecutive patients who underwent RRP for prostate cancer between January 1972 and December 2005. We identified 1383 patients with a GS a;circ 6 in prostatectomy specimens. Median follow-up was 8.3 years. Data on pathological and clinical characteristics and outcome were prospectively recorded. Statistical analysis was performed using the stratified log-rank test and stepwise Cox regression analysis. RESULTS A GS of 6 was present in 66%, 5 in 27%, 4 in 5% and 3 or 2 in 3% of cases. Tumour classification was pT2N0 (83%), pT3N0 (14%), pT4N0 (0.1%) and any TN1 (2%). Positive margins were seen in 18%. Estimated PSA and clinical recurrence rate were 14% and 4% after 10 years and 18% and 6% after 15 years, respectively. In multivariate analysis, N-stage (P < 0.001), T-stage (P= 0.02) and margin status (P < 0.001) were associated with PSA recurrence. N-stage (P < 0.001) and T-stage (P= 0.01) were associated with clinical recurrence. Overall, patients with a GS ≤ 6 accounted for 26% of all PSA recurrences and for 20% of all patients with clinical recurrences in the database. CONCLUSION âcent A relatively small proportion of patients with a GS a;circ 6 cancer developed PSA recurrence and/or overt metastasis. However, these patients account for a substantial minority of those who experienced recurrence and metastasis.

KW - Gleason score ≤6

KW - metastasis

KW - prognosis

KW - prostate cancer

KW - risk factors

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