Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy

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Abstract

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Men with high-risk prostate cancer experience recurrence, metastases and death at the highest rate in the prostate cancer population. Pathological stage at radical prostatectomy (RP) is the greatest predictor of recurrence and mortality in men with high-grade disease. Preoperative models predicting outcome after RP are skewed by the large proportion of men with low- and intermediate-risk features; there is a paucity of data about preoperative criteria to identify men with high-grade cancer who may benefit from RP. The present study adds comprehensive biopsy data from a large cohort of men with high-grade prostate cancer at biopsy. By adding biopsy parameters, e.g. number of high-grade cores and >50% involvement of any core, to traditional predictors of outcome (prostate-specific antigen concentration, clinical stage and Gleason sum), we can better inform men who present with high-grade prostate cancer as to their risk of favourable or unfavourable disease at RP. OBJECTIVE To investigate preoperative characteristics that distinguish favourable and unfavourable pathological and clinical outcomes in men with high biopsy Gleason sum (8-10) prostate cancer to better select men who will most benefit from radical prostatectomy (RP). PATIENTS AND METHODS The Institutional Review Board-approved institutional RP database (1982-2010) was analysed for men with high-Gleason prostate cancer on biopsy; 842 men were identified. The 10-year biochemical-free (BFS), metastasis-free (MFS) and prostate cancer-specific survival (CSS) were calculated using the Kaplan-Meier method to verify favourable pathology as men with Gleason 10 ng/mL (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.38-3.62, P= 0.001), advanced clinical stage (≥ cT2b; OR 2.55, 95% CI 1.55-4.21, P <0.001), Gleason pattern 9 or 10 at biopsy (OR 2.55, 95% CI 1.59-4.09, P <0.001), increasing number of cores positive with high-grade cancer (OR 1.16, 95% CI 1.01-1.34, P= 0.04) and >50% positive core involvement (OR 2.25, 95% CI 1.17-4.35, P= 0.015) were predictive of unfavourable pathology. CONCLUSIONS Men with high-Gleason sum at biopsy are at high risk for biochemical recurrence, metastasis and death after RP; men with high Gleason sum and advanced pathological stage (pT3b or N1) have the worst prognosis. Among men with high-Gleason sum at biopsy, a PSA concentration of >10 ng/mL, clinical stage ≥ T2b, Gleason pattern 9 or 10, increasing number of cores with high-grade cancer and >50% core involvement are predictive of unfavourable pathology.

Original languageEnglish (US)
Pages (from-to)1122-1128
Number of pages7
JournalBJU International
Volume110
Issue number8
DOIs
StatePublished - Oct 2012

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Prostatectomy
Prostatic Neoplasms
Biopsy
Odds Ratio
Confidence Intervals
Pathology
Neoplasm Metastasis
Recurrence
Research Ethics Committees
Prostate-Specific Antigen
Neoplasms

Keywords

  • Gleason sum
  • high-risk
  • outcomes
  • prostate cancer

ASJC Scopus subject areas

  • Urology

Cite this

@article{29fb4c6d0a5a41e998bcfb6977d3215a,
title = "Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy",
abstract = "Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Men with high-risk prostate cancer experience recurrence, metastases and death at the highest rate in the prostate cancer population. Pathological stage at radical prostatectomy (RP) is the greatest predictor of recurrence and mortality in men with high-grade disease. Preoperative models predicting outcome after RP are skewed by the large proportion of men with low- and intermediate-risk features; there is a paucity of data about preoperative criteria to identify men with high-grade cancer who may benefit from RP. The present study adds comprehensive biopsy data from a large cohort of men with high-grade prostate cancer at biopsy. By adding biopsy parameters, e.g. number of high-grade cores and >50{\%} involvement of any core, to traditional predictors of outcome (prostate-specific antigen concentration, clinical stage and Gleason sum), we can better inform men who present with high-grade prostate cancer as to their risk of favourable or unfavourable disease at RP. OBJECTIVE To investigate preoperative characteristics that distinguish favourable and unfavourable pathological and clinical outcomes in men with high biopsy Gleason sum (8-10) prostate cancer to better select men who will most benefit from radical prostatectomy (RP). PATIENTS AND METHODS The Institutional Review Board-approved institutional RP database (1982-2010) was analysed for men with high-Gleason prostate cancer on biopsy; 842 men were identified. The 10-year biochemical-free (BFS), metastasis-free (MFS) and prostate cancer-specific survival (CSS) were calculated using the Kaplan-Meier method to verify favourable pathology as men with Gleason 10 ng/mL (odds ratio [OR] 2.24, 95{\%} confidence interval [CI] 1.38-3.62, P= 0.001), advanced clinical stage (≥ cT2b; OR 2.55, 95{\%} CI 1.55-4.21, P <0.001), Gleason pattern 9 or 10 at biopsy (OR 2.55, 95{\%} CI 1.59-4.09, P <0.001), increasing number of cores positive with high-grade cancer (OR 1.16, 95{\%} CI 1.01-1.34, P= 0.04) and >50{\%} positive core involvement (OR 2.25, 95{\%} CI 1.17-4.35, P= 0.015) were predictive of unfavourable pathology. CONCLUSIONS Men with high-Gleason sum at biopsy are at high risk for biochemical recurrence, metastasis and death after RP; men with high Gleason sum and advanced pathological stage (pT3b or N1) have the worst prognosis. Among men with high-Gleason sum at biopsy, a PSA concentration of >10 ng/mL, clinical stage ≥ T2b, Gleason pattern 9 or 10, increasing number of cores with high-grade cancer and >50{\%} core involvement are predictive of unfavourable pathology.",
keywords = "Gleason sum, high-risk, outcomes, prostate cancer",
author = "Pierorazio, {Phillip Martin} and Ross, {Ashley E.} and Lin, {Brian M.} and Epstein, {Jonathan Ira} and Misop Han and Patrick Walsh and Partin, {Alan Wayne} and Christian Pavlovich and Schaeffer, {Edward M.}",
year = "2012",
month = "10",
doi = "10.1111/j.1464-410X.2012.10986.x",
language = "English (US)",
volume = "110",
pages = "1122--1128",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy

AU - Pierorazio, Phillip Martin

AU - Ross, Ashley E.

AU - Lin, Brian M.

AU - Epstein, Jonathan Ira

AU - Han, Misop

AU - Walsh, Patrick

AU - Partin, Alan Wayne

AU - Pavlovich, Christian

AU - Schaeffer, Edward M.

PY - 2012/10

Y1 - 2012/10

N2 - Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Men with high-risk prostate cancer experience recurrence, metastases and death at the highest rate in the prostate cancer population. Pathological stage at radical prostatectomy (RP) is the greatest predictor of recurrence and mortality in men with high-grade disease. Preoperative models predicting outcome after RP are skewed by the large proportion of men with low- and intermediate-risk features; there is a paucity of data about preoperative criteria to identify men with high-grade cancer who may benefit from RP. The present study adds comprehensive biopsy data from a large cohort of men with high-grade prostate cancer at biopsy. By adding biopsy parameters, e.g. number of high-grade cores and >50% involvement of any core, to traditional predictors of outcome (prostate-specific antigen concentration, clinical stage and Gleason sum), we can better inform men who present with high-grade prostate cancer as to their risk of favourable or unfavourable disease at RP. OBJECTIVE To investigate preoperative characteristics that distinguish favourable and unfavourable pathological and clinical outcomes in men with high biopsy Gleason sum (8-10) prostate cancer to better select men who will most benefit from radical prostatectomy (RP). PATIENTS AND METHODS The Institutional Review Board-approved institutional RP database (1982-2010) was analysed for men with high-Gleason prostate cancer on biopsy; 842 men were identified. The 10-year biochemical-free (BFS), metastasis-free (MFS) and prostate cancer-specific survival (CSS) were calculated using the Kaplan-Meier method to verify favourable pathology as men with Gleason 10 ng/mL (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.38-3.62, P= 0.001), advanced clinical stage (≥ cT2b; OR 2.55, 95% CI 1.55-4.21, P <0.001), Gleason pattern 9 or 10 at biopsy (OR 2.55, 95% CI 1.59-4.09, P <0.001), increasing number of cores positive with high-grade cancer (OR 1.16, 95% CI 1.01-1.34, P= 0.04) and >50% positive core involvement (OR 2.25, 95% CI 1.17-4.35, P= 0.015) were predictive of unfavourable pathology. CONCLUSIONS Men with high-Gleason sum at biopsy are at high risk for biochemical recurrence, metastasis and death after RP; men with high Gleason sum and advanced pathological stage (pT3b or N1) have the worst prognosis. Among men with high-Gleason sum at biopsy, a PSA concentration of >10 ng/mL, clinical stage ≥ T2b, Gleason pattern 9 or 10, increasing number of cores with high-grade cancer and >50% core involvement are predictive of unfavourable pathology.

AB - Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Men with high-risk prostate cancer experience recurrence, metastases and death at the highest rate in the prostate cancer population. Pathological stage at radical prostatectomy (RP) is the greatest predictor of recurrence and mortality in men with high-grade disease. Preoperative models predicting outcome after RP are skewed by the large proportion of men with low- and intermediate-risk features; there is a paucity of data about preoperative criteria to identify men with high-grade cancer who may benefit from RP. The present study adds comprehensive biopsy data from a large cohort of men with high-grade prostate cancer at biopsy. By adding biopsy parameters, e.g. number of high-grade cores and >50% involvement of any core, to traditional predictors of outcome (prostate-specific antigen concentration, clinical stage and Gleason sum), we can better inform men who present with high-grade prostate cancer as to their risk of favourable or unfavourable disease at RP. OBJECTIVE To investigate preoperative characteristics that distinguish favourable and unfavourable pathological and clinical outcomes in men with high biopsy Gleason sum (8-10) prostate cancer to better select men who will most benefit from radical prostatectomy (RP). PATIENTS AND METHODS The Institutional Review Board-approved institutional RP database (1982-2010) was analysed for men with high-Gleason prostate cancer on biopsy; 842 men were identified. The 10-year biochemical-free (BFS), metastasis-free (MFS) and prostate cancer-specific survival (CSS) were calculated using the Kaplan-Meier method to verify favourable pathology as men with Gleason 10 ng/mL (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.38-3.62, P= 0.001), advanced clinical stage (≥ cT2b; OR 2.55, 95% CI 1.55-4.21, P <0.001), Gleason pattern 9 or 10 at biopsy (OR 2.55, 95% CI 1.59-4.09, P <0.001), increasing number of cores positive with high-grade cancer (OR 1.16, 95% CI 1.01-1.34, P= 0.04) and >50% positive core involvement (OR 2.25, 95% CI 1.17-4.35, P= 0.015) were predictive of unfavourable pathology. CONCLUSIONS Men with high-Gleason sum at biopsy are at high risk for biochemical recurrence, metastasis and death after RP; men with high Gleason sum and advanced pathological stage (pT3b or N1) have the worst prognosis. Among men with high-Gleason sum at biopsy, a PSA concentration of >10 ng/mL, clinical stage ≥ T2b, Gleason pattern 9 or 10, increasing number of cores with high-grade cancer and >50% core involvement are predictive of unfavourable pathology.

KW - Gleason sum

KW - high-risk

KW - outcomes

KW - prostate cancer

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