After radical prostatectomy, high Gleason score, T grade, positive cores, positive margins predict recurrence

[JimJimJimJim]

If you have had a radical prostatectomy, Gleason score of 8 or more, a grade of T3, positive margins, or cancer in more than half the prostate you have a greater risk of your PSA beginning to rise within 5 years as the cancer returns.

If you have two or more of these risk factors, you have more than a 50% chance of your PSA beginning to rise within 5 years as the cancer returns.

When doctors examine your prostate after they have taken it out they get a more accurate Gleason score and T grade. During the operation, after they have taken away the prostate, they take samples from your body at the edge of the cuts they made. This is later tested in the lab so they are pretty sure they got everything. If this test shows that there are some cancer cells left inside you, you are said to have positive margins.

This paper is based on those more accurate scores after the operation, which can be quite different from the scores they got by biopsy before the operation.

These Spanish researchers would suggest adding radiation to your surgery if you have 2 or more of these risk factors.

Your doctor will consider this paper, evidence from other papers, your doctor's experience with similar cases, your age, your health history, your health now, your life circumstances, your wishes, and many other factors before recommending, or not recommending, radiation for you.

Arch Esp Urol. 2012 Jan-Feb;65(1):158-65.

[Risk factors for biochemical recurrence after radical prostatectomy in patients with clinically localized prostate cancer. Implications of adjuvant treatment].

[Article in Spanish]

Fagundo EV, Amo FH, López EL, Sánchez JP, Jiménez Gdel P, Chamizo JA, Cordero JM, Fernández ME, Fernández CH.

Source

Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España. nissangaviota@gmail.com

Abstract

To evaluate the pathological variables predictive of biochemical recurrence after radical prostatectomy and their implications for decision making in the adjuvant setting.

METHODS:

684 patients with localized prostate cancer who were treated with radical prostatectomy between 1996 and 2007. Before surgery they were classified according to D'Amico risk groups for recurrence. Following prostatectomy the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins, perineural invasion and percentage of involvement in the piece. Univariate analysis was performed and subsequently adjusted using a Cox proportional hazards model (method enter).

RESULTS:

The median follow up of the series was 61 months. 29.1% of patients had biochemical recurrence. Overall mortality of the series was 4.9% and cancer-specific mortality 1.2%. In univariate analysis the Gleason score of surgical specimens, capsular invasion, perineural invasion, involvement of surgical margins, pathological stage and percentage of involvement of the piece had statistically significant (p <0.001) relation with biochemical recurrence. In multivariate analysis, a Gleason score ≥ 8 in the surgical specimen (HR = 3.08), existence of affected surgical margins (HR = 2.98), pT3 stage (HR = 1.61) and involvement of more than 50% of the piece by cancer (HR = 3.39) were identified as independent predictors of biochemical recurrence. Stratifying by independent predictors of biochemical recurrence (pT, Gleason score and margin), patients with at least 2 of these factors had an incidence of biochemical recurrence at 5 years exceeding 50%.

CONCLUSIONS:

Patients who have a Gleason score ≥ 8, positive margins, pT3 tumour or a percentage of >50% after prostatectomy have an increased risk of biochemical recurrence. Patients with at least 2 predictors of relapse have a probability of recurrence over 50% in the first 5 years of recurrence and should therefore be candidates for adjuvant radiotherapy.

PMID: 22318186