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Multiple cores of G leason score 6 correlate with favourable findings at radical prostatectomy
Author(s) -
Ellis Carla L.,
Walsh Patrick C.,
Partin Alan W.,
Epstein Jonathan I.
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2012.11680.x
Subject(s) - prostatectomy , medicine , prostate cancer , biopsy , urology , biochemical recurrence , cancer
What's known on the subject? and What does the study add? Previous studies have reported variable outcomes at radical prostatectomy ( RP ) with G leason score 6 ( GS 6) on biopsy. It has been shown that a significant proportion of patients with GS6 disease at biopsy are upgraded to G leason score 7 or higher after RP , increasing the risk of an adverse outcome. However, such studies have focused on clinical parameters such as PSA , prostate volume and biopsy cancer volume, in concert with GS6, to predict clinically significant upgrading. The present study is the first to use a significant number of patients with the aim of specifically analyzing the outcome at RP (i.e. percentage organ‐confined, margin status, overall grade and biochemical recurrence) and making a direct correlation with the number of positive cores to show that the overall prognosis is favourable.Objective To establish whether the good prognosis of Gleason score 6 ( GS 6) is maintained in the setting of multiple involved cores.Patients and Methods In total, 6156 men (from 1 A pril 2000 to 30 A pril 2007) with GS6 on biopsy underwent radical prostatectomy ( RP ) at our institution. The number of positive cores was correlated with the outcome at RP .Results More positive cores correlated with less organ‐confined disease ( P < 0.001), positive margins ( P < 0.012), increasing RP grade ( P < 0.001) and increased seminal vesicles/lymph node involvement ( P = 0.012). For men with data available, the actuarial risk of being biochemically free of disease at 5 years was 93.2% when ≤6 cores were positive (812 men followed to 5 years) vs 89.1% if >6 cores were positive (41 men followed to 2 years) ( P = 0.6). Although the predicted ‘cure rate’ of >75% probability of a tumour showing no evidence of biochemical recurrence at 10 years after RP was statistically different between cases with ≤6 vs >6 positive cores ( P < 0.0001), the outcome in both groups was still favourable (90.5% vs 84%). Partin‐like tables were generated factoring in the number of positive cores to predict organ‐confined disease as a guide for urologists to perform nerve‐sparing surgery. For example, with T1c disease, there was a ≥75% probability of organ‐confined disease with one to three positive cores regardless of prostate‐specific antigen ( PSA ) level, and the same probability was present with four to six positive cores and a PSA level of 0–4 ng/mL.Conclusion A low G leason score on biopsy is a powerful prognostic finding, such that this favourable outcome is maintained even in the setting of multiple positive cores with GS 6.