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Prostate‐specific antigen level, stage or Gleason score: Which is best for predicting outcomes after radical prostatectomy, and does it vary by the outcome being measured? Results from Shared Equal Access Regional Cancer Hospital database
Author(s) -
Mithal Prabhakar,
Howard Lauren E,
Aronson William J,
Kane Christopher J,
Cooperberg Matthew R,
Terris Martha K,
Amling Christopher L,
Freedland Stephen J
Publication year - 2015
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12704
Subject(s) - medicine , prostatectomy , prostate cancer , prostate specific antigen , stage (stratigraphy) , nomogram , biochemical recurrence , urology , prostate , surgical margin , oncology , cancer , pathological , paleontology , biology
Objectives To assess the ability of preoperative prostate‐specific antigen level, Gleason score and stage to predict prostate cancer outcomes beyond biochemical recurrence, specifically castration‐resistant prostate cancer, metastases and prostate cancer‐specific mortality in radical prostatectomy patients. Methods We carried out a retrospective study of 2735 men in the Shared Equal Access Regional Cancer Hospital database treated by radical prostatectomy from 1988 to 2011 with data available on pathological stage, grade and preoperative prostate‐specific antigen. We used Cox hazards analyses to examine the predictive accuracy (c‐index) of the preoperative prostate‐specific antigen (log‐transformed), path Gleason score (≤7, 3 + 4, 4 + 3 and 8–10) and path stage grouping (pT2 negative margins; pT2 positive margins; pT3a negative margins; pT3a positive margins; pT3b; vs positive nodes) to predict biochemical recurrence, castration‐resistant prostate cancer, metastases and prostate cancer‐specific mortality. Results Median follow up was 8.7 years, during which, 937 (34%) had biochemical recurrence, 108 (4%) castration‐resistant prostate cancer, 127 (5%) metastases and 68 (2%) prostate cancer‐specific mortality. For the outcomes of biochemical recurrence, castration‐resistant prostate cancer, metastases and prostate cancer‐specific mortality, the c‐indices were, respectively: prostate‐specific antigen 0.65, 0.66, 0.64 and 0.69; Gleason score 0.66, 0.83, 0.76 and 0.85; and pathological stage group 0.69, 0.76, 0.72 and 0.80. Conclusions Gleason score can predict with very high accuracy prostate cancer‐specific mortality in patients undergoing radical prostatectomy. Thus, Gleason score should be given more weight in nomograms to predict prostate cancer‐specific mortality. Furthermore, men with a high Gleason score should be given special consideration for adjuvant treatment or referral to clinical trials because of a higher risk of prostate cancer‐specific mortality. © 2015 The Japanese Urological Association