Efficacy of Radical Retropubic Prostatectomy in Patients with Clinically Localized Prostate Cancer and a Biopsy Gleason Score of 8 or Higher

Jun Hyun Han; In Ho Chang; Ji Hyeong Yu; Byoung Kyu Han; Seong Jin Jeong; Sung Kyu Hong; Seok-Soo Byun; Sang Eun Lee

doi:10.4111/kju.2007.48.6.592

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Han, Chang, Yu, Han, Jeong, Hong, Byun, and Lee: Efficacy of Radical Retropubic Prostatectomy in Patients with Clinically Localized Prostate Cancer and a Biopsy Gleason Score of 8 or Higher

Original Article

Korean J Urol 2007;48(6):592-597.

Published online: 20 January 2007

DOI: https://doi.org/10.4111/kju.2007.48.6.592

Efficacy of Radical Retropubic Prostatectomy in Patients with Clinically Localized Prostate Cancer and a Biopsy Gleason Score of 8 or Higher

Jun Hyun Han, In Ho Chang, Ji Hyeong Yu¹, Byoung Kyu Han², Seong Jin Jeong², Sung Kyu Hong², Seok-Soo Byun², Sang Eun Lee²

From the Department of Urology, KEPCO Medical Foundation Hanil General, Inje University College of Hospital, Seongnam, Korea

¹Inje University Sanggye Baik Hospital, Inje University College of Hospital, Seongnam, Korea

²Seoul National University Bundang Hospital, Seoul National Medicine, Seoul, University College of Medicine, Seongnam, Korea

Received 2 February 2007 Accepted 30 April 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We retrospectively reviewed clinicopathological characteristics in patients who underwent radical retropubic prostatectomy (RRP) with clinically localized prostate cancer and a biopsy Gleason score of 8 or higher.

Materials and Methods

Among 266 patients who underwent RRP without prior any neoadjuvant therapy between March 2004 and March 2006, 29 patients had clinically localized prostate cancer and a biopsy Gleason score of 8 or higher. We analyzed several clinicopathologic factors that predict organ-confined disease, and also investigated the impact on postoperative changes of the biopsy Gleason score.

Results

Of 29 patients, 12 (41.4%) had organ-confined cancer. Serum prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), tumor volume, and tumor percentage were significant factors for predicting organ-confined cancer (p＜0.05). The number of the positive core, percentage of the positive core, sum of the tumor length of the positive core, tumor percentage of total core length, and tumor percentage of the positive core length were also significantly higher in the group with an extraprostatic extension compared to the organ-confined cancer group (p＜ 0.05). Of 29 patients, 14 (48.3%) were downgraded to a Gleason score of 7 or less and had a higher chance (64.3%; p=0.016) of experiencing organ-confined disease than those that remained at Gleason scores of 8–10.

Conclusions

Among patients with clinical localized prostate cancer and a biopsy Gleason score of 8 or higher, radical prostatectomy can be considered for primary treatment in some cases with low PSA and PSAD and low predictive volume of the tumor from biopsy results.

Keywords: Prostatectomy, Biopsy, Prostatic neoplasms

References

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Table 1.

Characteristics of a biopsy Gleason score of 7 versus those of 8–10 after radical retropubic prostatectomy

Characteristics	Biopsy Gleason score		p-value
Characteristics	≤7	8–10	p-value
No. of patients	237 (89.1%)	29 (10.9%)
Mean age (year)	64.2±6.8	64.6±5.7	0.772
Mean BMI (kg/m²)	24.7±2.7	24.8±3.3	0.833
Mean PSA (ng/ml)	9.5±8.3	17.5±14.2	＜0.001
Mean TRUS vol. (ml)	41.6±17.4	35.3±7.0	0.093
Mean postop. prostate vol. (ml)	39.7±13.7	36.4±11.2	0.209
Mean tumor/ prostate vol. ratio	0.16±0.17	0.31±0.23	＜0.001
Mean tumor vol. (ml)	5.3±5.9	10.9±8.2	＜0.001
Organ confined	195 (82.3%)	12 (41.4%)	＜0.001^∗
Extraprostatic extension	42 (17.7%)	17 (58.6%)
Surgical margin (−)	200 (84.4%)	14 (48.3%)	＜0.001^∗
Surgical margin (+)	37 (15.6%)	15 (51.7%)
LN metastasis	0	2	0.012

BMI: body mass index, PSA: prostate-specific antigen, TRUS: transrectal ultrasonography, PSAD: prostate-specific antigen density, ∗chi-square test

Table 2.

Characteristics of the clinicopathologic factors for organ-confined disease with a biopsy Gleason score of 8–10

Characteristics	Organ confined	Extraprostatic extension	p-value
No. of patients	12 (41.4%)	17 (58.6%)
Mean age (year)	63.6±4.8	65.2±6.3	0.454
Mean BMI (kg/m²)	25.0±3.8	24.7±2.9	0.838
Mean PSA (ng/ml)	11.1±9.1	18.7±9.3	0.022
Mean PSAD (ng/ml/ml)	0.31±0.30	0.63±0.36	0.018
Mean TRUS volume (ml)	35.1±6.8	35.4±7.4	0.927
Biopsy Gleason score 8	9 (75.0%)	10 (58.8%)	0.449^∗
Biopsy Gleason score 9	3 (25.0%)	7 (41.2%)
Mean postop. prostate vol. (ml)	39.7±6.5	34.0±13.3	0.189
Mean tumor/ prostate vol. ratio	0.18±0.15	0.39±0.24	0.013
Mean tumor vol. (ml)	7.3±6.4	13.4±8.6	0.045
Surgical margin (−)	9 (75.0%)	5 (29.4%)	0.025^∗
Surgical margin (+)	3 (25.0%)	12 (70.6%)

^∗ chi-square test

Table 3.

Analysis of the needle biopsy factors for organ-confined disease with a biopsy Gleason score of 8–10

Biopsy factor	Organ confined	Extraprostatic extension	p-value
No. of positive core	3.8±2.8	7.5±3.5	0.005^∗
Percentage of positive core (%)	37.8±27.1	59.5±26.3	0.039
Sum of tumor length of positive core (mm)	1.9±1.8	4.9±3.0	0.004
Tumor percentage of total biopsy core length (%)	13.6±13.2	30.6±22.9	0.029
Tumor percentage of positive biopsy core length (%)	32.5±17.5	47.7±15.1	0.019

^∗ Mann-Whitney test

Table 4.

Association between organ-confined disease and patients with a downgraded Gleason score

Characteristics	Organ confined	Extraprostatic extension	p-value
Patients with downgraded Gleason score	10 (58.8%)	7 (41.2%)	0.023^∗
Patients without downgraded Gleason score	2 (16.7%)	10 (83.3%)
Patients with downgraded Gleason score below 7	9 (64.3%)	5 (35.7%)	0.016^∗
Patients without downgraded Gleason score below 7	3 (20.0%)	12 (80.0%)

^∗ chi-square test

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