[800] Do Patients with Multiple Positive Cores of Gleason Score 6 (GS6) Adenocarcinoma on Biopsy Have Unfavorable Findings at Radical Prostatectomy (RP)?

Carla L Ellis, Jonathan I Epstein. The Johns Hopkins Hospital, Baltimore

Background: While the presence of GS6 on biopsy is a relatively favorable finding, it is unknown is whether its good prognosis is maintained in the setting of multiple involved cores.
Design: We identified 6,156 men (4/1/00-4/30/07) with GS6 on biopsy who underwent RP at our institution. A “cure rate” was determined by a >75% probability of tumor showing no evidence of biochemical recurrence 10 years after RP as calculated by the Han tables (based on pre-operative PSA, GS at radical prostatectomy and status of organ confinement). We also evaluated the fraction of positive cores (positive cores/total cores); positive cores and fraction of positive cores were so tightly correlated (R=0.94) that there was no meaningful difference between the two variables and the number of positive cores was utilized.
Results: The number of positive cores averaged 2.5 (1-16). More positive cores statistically correlated with lower cure rate (p<0.0001), less organ-confined disease (p<0.0001), positive margins (p<0.001), and increasing RP grade (p<0.001).

Table
# of Positive CoresCure Rate > 75%Percent OCNegative MarginsRP GS6
1-690.5%82.5%89.3%77.2%
>684.0%68.3%85.2%66.4%
     
193%88%93%82%
290%83%88%75%
389%77%88%75%
488%77%86%70%
586%70%80%72%
684%67%82%73%
785%64%83%70%
885%77%87%64%
981%62%89%68%
>1083%71%85%63%


Non-focal extra-prostatic extension (EPE) was seen in 7.9% and 13.1% of cases with 1-6 vs. >6 positive cores, respectively. Positive seminal vesicles or lymph nodes were seen in 1.5% and 3.5% of cases with 1-6 vs. >6 positive cores, respectively. However, even with multiple positive cores of GS6, the majority of patients had a relatively favorable outcome such that RP remains a viable option in this setting [Table]. Tables were also generated based on clinical stage (T1c vs T2), number of positive cores, and preoperative PSA level to predict organ confined disease as a guide for urologists to perform nerve sparing surgery. For example with nonpalpable disease (T1c), there was a ≥75% likelihood of organ confined disease with 1-3 positive cores regardless of PSA and with 4-6 positive cores & PSA 0-4 ng/ml.
Conclusions: Low Gleason score on biopsy is such a powerful prognostic finding, such that this favorable outcome is maintained even in the setting of multiple positive cores with GS6.
Category: Genitourinary (including renal tumors)

Wednesday, March 2, 2011 9:30 AM

Poster Session V # 68, Wednesday Morning

 

Close Window