Skip to main content
SpringerLink
Log in

Impact of Gleason score on biochemical recurrence in patients with pT3aN0/Nx prostate cancer with positive surgical margins: a multicenter study from the Prostate Cancer Research Committee

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Oncologic outcomes of patients with pT3aN0/Nx prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP) are heterogeneous. We investigated the impact of Gleason score (GS) on biochemical recurrence (BCR) in these patients.

Methods

A retrospective, multicenter study was performed on 795 patients with pT3aN0/Nx PCa with PSM after RP between January 2006 and December 2014. Clinicopathologic characteristics of patients were examined and onset of BCR was identified. Kaplan–Meier survival analysis was used to illustrate BCR-free survival (BFS) and Cox proportional hazard models were applied to identify factors predicting BCR.

Results

During the mean follow-up period of 63.9 months, BCR was identified in 274 (34.5%) patients. The 5-year BFS was 56.6% in all patients. In multivariate analysis, pathologic GS was the only significant prognostic factor for BCR in patients with pT3aN0/Nx PCa with PSM (GS 6 vs. GS 7 (3 + 4), P = 0.047; vs. GS 7 (4 + 3), P = 0.007, and vs. GS 8–10, P < 0.001). When patients were stratified according to GS, 5-year BFS was 78.6% in GS 6, 66.2% in GS 7 (3 + 4), 51.1% in GS 7 (4 + 3) and 35.5% in GS 8–10.

Conclusions

In patients with pT3aN0/Nx with PSM after RP, pathologic GS is the sole independent predictor for risk stratification of BCR. These findings might be used to determine the risk and timing of BCR and to help counsel patients regarding treatment strategy and prognosis of disease on an individual basis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Abdollah F, Suardi N, Cozzarini C, Gallina A, Capitanio U, Bianchi M, Sun M, Fossati N, Passoni NM, Fiorino C, Di Muzio N, Karakiewicz PI, Rigatti P, Montorsi F, Briganti A (2013) Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate cancer: a long-term survival analysis. Eur Urol 63:998–1008

    Article  PubMed  Google Scholar 

  • Bianco FJ Jr, Scardino PT, Eastham JA (2005) Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (“trifecta”). Urology 66:83–94

    Article  PubMed  Google Scholar 

  • Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L, de Reijke TM, Verbaeys A, Bosset JF, van Velthoven R, Marechal JM, Scalliet P, Haustermans K, Pierart M, European Organization for R, Treatment of C (2005) Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 366:572–578

    Article  PubMed  Google Scholar 

  • Cao D, Kibel AS, Gao F, Tao Y, Humphrey PA (2010) The Gleason score of tumor at the margin in radical prostatectomy is predictive of biochemical recurrence. Am J Surg Pathol 34:994–1001

    Article  PubMed  Google Scholar 

  • Chun FK, Graefen M, Zacharias M, Haese A, Steuber T, Schlomm T, Walz J, Karakiewicz PI, Huland H (2006) Anatomic radical retropubic prostatectomy-long-term recurrence-free survival rates for localized prostate cancer. World J Urol 24:273–280

    Article  PubMed  Google Scholar 

  • D’Amico AV, Cote K, Loffredo M, Renshaw AA, Schultz D (2002) Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol 20:4567–4573

    Article  PubMed  Google Scholar 

  • Epstein JI (2010) An update of the Gleason grading system. J Urol 183:433–440

    Article  PubMed  Google Scholar 

  • Gandaglia G, Karakiewicz PI, Briganti A, Trudeau V, Trinh QD, Kim SP, Montorsi F, Nguyen PL, Abdollah F, Sun M (2015) Early radiotherapy after radical prostatectomy improves cancer-specific survival only in patients with highly aggressive prostate cancer: validation of recently released criteria. Int J Urol 22:89–95

    Article  PubMed  Google Scholar 

  • Han M, Partin AW, Pound CR, Epstein JI, Walsh PC (2001) Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin N Am 28:555–565

    Article  CAS  Google Scholar 

  • Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Mottet N, Schmid HP, van der Kwast T, Wiegel T, Zattoni F, European Association of U (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71

    Article  PubMed  Google Scholar 

  • Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N, European Association of U (2014) EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 65:467–479

    Article  CAS  PubMed  Google Scholar 

  • Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT (2002) Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 167:528–534

    Article  PubMed  Google Scholar 

  • Karl A, Buchner A, Tympner C, Kirchner T, Ganswindt U, Belka C, Ganzer R, Wieland W, Eder F, Hofstadter F, Schilling D, Sievert KD, Stenzl A, Scharpf M, Fend F, Vom Dorp F, Rubben H, Schmid KW, Porres-Knoblauch D, Heidenreich A, Hangarter B, Knuchel-Clarke R, Rogenhofer M, Wullich B, Hartmann A, Comploj E, Pycha A, Hanspeter E, Pehrke D, Sauter G, Graefen M, Gratzke C, Stief C, Wiegel T, Haese A (2015) Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin—a multicenter study. Radiother Oncol 116:119–124

    Article  PubMed  Google Scholar 

  • Mian BM, Troncoso P, Okihara K, Bhadkamkar V, Johnston D, Reyes AO, Babaian RJ (2002) Outcome of patients with Gleason score 8 or higher prostate cancer following radical prostatectomy alone. J Urol 167:1675–1680

    Article  PubMed  Google Scholar 

  • Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ (2004) Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 172:910–914

    Article  PubMed  Google Scholar 

  • Song W, Kwon YS, Jeon SS, Kim IY (2017) Refining the American Urological Association and American Society for Radiation Oncology guideline for adjuvant radiotherapy after radical prostatectomy using the pathologic Gleason score. Asian J Androl 19:20–25

    PubMed  Google Scholar 

  • Srigley JR, Humphrey PA, Amin MB, Chang SS, Egevad L, Epstein JI, Grignon DJ, McKiernan JM, Montironi R, Renshaw AA, Reuter VE, Wheeler TM, Members of the Cancer Committee CoAP (2009) Protocol for the examination of specimens from patients with carcinoma of the prostate gland. Arch Pathol Lab Med 133:1568–1576

    PubMed  Google Scholar 

  • Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, DiBlasio CJ, Reuther A, Klein EA, Kattan MW (2005) Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 23:7005–7012

    Article  PubMed  PubMed Central  Google Scholar 

  • Stephenson AJ, Wood DP, Kattan MW, Klein EA, Scardino PT, Eastham JA, Carver BS (2009) Location, extent and number of positive surgical margins do not improve accuracy of predicting prostate cancer recurrence after radical prostatectomy. J Urol 182:1357–1363

    Article  PubMed  Google Scholar 

  • Suardi N, Porter CR, Reuther AM, Walz J, Kodama K, Gibbons RP, Correa R, Montorsi F, Graefen M, Huland H, Klein EA, Karakiewicz PI (2008) A nomogram predicting long-term biochemical recurrence after radical prostatectomy. Cancer 112:1254–1263

    Article  PubMed  Google Scholar 

  • Swanson GP, Riggs M, Hermans M (2007) Pathologic findings at radical prostatectomy: risk factors for failure and death. Urol Oncol 25:110–114

    Article  PubMed  Google Scholar 

  • Thompson IM Jr, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, Canby-Hagino E, Crawford ED (2006) Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 296:2329–2335

    Article  CAS  PubMed  Google Scholar 

  • Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, Klein E, Michalski J, Roach M, Sartor O, Wolf JS Jr, Faraday MM (2013) Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline. J Urol 190:441–449

    Article  PubMed  Google Scholar 

  • Udo K, Cronin AM, Carlino LJ, Savage CJ, Maschino AC, Al-Ahmadie HA, Gopalan A, Tickoo SK, Scardino PT, Eastham JA, Reuter VE, Fine SW (2013) Prognostic impact of subclassification of radical prostatectomy positive margins by linear extent and Gleason grade. J Urol 189:1302–1307

    Article  PubMed  Google Scholar 

  • Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Storkel S, Willich N, Semjonow A, Souchon R, Stockle M, Rube C, Weissbach L, Althaus P, Rebmann U, Kalble T, Feldmann HJ, Wirth M, Hinke A, Hinkelbein W, Miller K (2009) Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 27:2924–2930

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was performed by the Prostate Cancer Research Committee of the Korean Urological Oncology Society.

Author information

Authors and Affiliations

  1. Department of Urology, School of Medicine, Ewha Womans University, Seoul, Korea

    Wan Song & Dong Hyeon Lee

  2. Department of Urology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea

    Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Hyun Moo Lee, Han Yong Choi & Seong Soo Jeon

  3. Department of Urology, Guro Hospital, Korea University, Seoul, Korea

    Jong Wook Kim

  4. Department of Urology, Bundang Hospital, Seoul National University, Seongnam, Korea

    SangChul Lee & Seok-Soo Byun

  5. Department of Urology, Seoul National University Hospital, Seoul, Korea

    Chang Wook Jeong & Cheol Kwak

  6. Department of Urology, College of Medicine, Hallym University, Chuncheon, Korea

    Jin Seon Cho

  7. Department of Urology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Hanjong Ahn

Authors
  1. Wan Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong Hyeon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hwang Gyun Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byong Chang Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seong Il Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyun Moo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Han Yong Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jong Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. SangChul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Seok-Soo Byun
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chang Wook Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Cheol Kwak
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jin Seon Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hanjong Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Seong Soo Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Hanjong Ahn or Seong Soo Jeon.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

No funding was received.

Informed consent

Written informed consent was exempted because of the retrospective study design.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, W., Lee, D.H., Jeon, H.G. et al. Impact of Gleason score on biochemical recurrence in patients with pT3aN0/Nx prostate cancer with positive surgical margins: a multicenter study from the Prostate Cancer Research Committee. J Cancer Res Clin Oncol 143, 2393–2400 (2017). https://doi.org/10.1007/s00432-017-2502-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-017-2502-7

Keywords

Search

Navigation