John M Watkins et al

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.