Clinical Stage Drives Outcome at Radical Prostatectomy (RP) with Gleason Score 9-10 (GS910) Prostatic Adenocarcinoma on Biopsy
Carla L Ellis, Jonathan I Epstein. Johns Hopkins Hospital, Baltimore, MD
Background: There is little data on the prognosis at RP when there is GS910 on biopsy.
Design: We identified 259 men (1987-2012) with GS910 on biopsy that underwent RP at our institution. We categorized age, race, pre-operative PSA (prePSA) level, location of adenocarcinoma, # of total biopsy cores, # of total positive cores, # of positive cores with GS910, maximum % of core length with GS910, maximum % of adenocarcinoma overall, and biochemical free survival (BFS) at 3 years. Clinical stages were combined into the following groups: Cstage1=T1c, T2a or T2b; Cstage2 = T2c; & Cstage3 = >T3. Pathological stage was grouped as: Organ confined (OC); Extra-prostatic extendion (EPE); Seminal vesicle invasion (SV); Lymph node (LN) metastases, based on the highest stage finding in a case (ie. case with SV & EPE designated as SV).
Results: 243/259 (94%) were GS9. The mean age was 60 yrs. and the majority were Caucasian. The mean prePSA level = 8.9, mean # of total cores = 12, mean # positive cores = 4, mean # of positive cores with GS910 = 2, mean maximum % adenocarcinoma per core = 66%; mean maximum % GS910 per core = 56%. At RP, 66% of men had GS910. Only 29% had OC. Many of the single variables were predictive of RP stage. Cstage was the best predictor at RP, with Cstage1 or 2 having a relatively favorable prognosis.
|Cstage||Total %||%OC||% Margins (+)||% LN (+)||% SV (+)||% BFS|