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Impact of the primary Gleason pattern on biochemical recurrence-free survival after radical prostatectomy: a single-center cohort of 1,248 patients with Gleason 7 tumors

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Abstract

Purpose

We aimed to evaluate the impact of the primary Gleason pattern on biochemical recurrence-free survival (RFS) after radical prostatectomy (RP) in a single-center cohort of patients with Gleason 7 tumors.

Materials and methods

From 1998 to 2008, 2,239 consecutive patients underwent RP for a localized prostate cancer. A total of 1,248 patients with Gleason score (GS) 7 cancers were included. Follow-up was standardized for all patients and recorded into a prospective database. Median postoperative follow-up was 23.4 months. Biochemical recurrence was defined by prostate-specific antigen level > 0.2 ng/ml.

Results

In all, 721 patients (57.8%) had a final GS of 3 + 4 and 527 (42.2%) of 4 + 3. Patients with GS 4 + 3 had a significantly higher risk of biochemical progression than those with GS 3 + 4 (P < 0.001). The 3- and 5-year biochemical RFS for Gleason score 3 + 4 cancers was 84.6 and 76.4%, respectively, versus 69.9 and 61.1% in Gleason score 4 + 3 cancers. Multivariate analysis showed that the primary Gleason remained statistically predictive for PSA failure (P = 0.018). When analysis was stratified by both pathologic stage and margin status, predictive value of primary Gleason was significant in pT2R0, pT3-4R0, and pT3-4R1 cancers, whereas survival curves were not statistically different in pT2R1 cancers (P = 0.672).

Conclusion

Primary Gleason 4 pattern is an independent predictor for PSA failure. Analysis of Gleason patterns provides clinically relevant prognostic information, which may assist in the management of patients with Gleason score 7 cancers.

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Abbreviations

Pca:

prostate cancer

PSA:

prostatic-specific antigen

RFS:

recurrence-free survival

RP:

radical prostatectomy

GS:

Gleason score

SM:

surgical margin

ECE:

extracapsular extension

SVI:

seminal vesicle invasion

R:

margin status (R1:positive margin; R0:negative margin)

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Conflict of interest

No financial disclosure, no conflict of interest.

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Authors and Affiliations

  1. Department of Urology and Pathology, INSERM U955 Eq07, CHU Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France

    Olivier Alenda, Guillaume Ploussard, Pascal Mouracade, Evanguelos Xylinas, Alexandre de la Taille, Yves Allory, Dimitri Vordos, Andras Hoznek, Claude Clement Abbou & Laurent Salomon

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  1. Olivier Alenda
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  2. Guillaume Ploussard
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  3. Pascal Mouracade
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  4. Evanguelos Xylinas
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  5. Alexandre de la Taille
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  6. Yves Allory
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  7. Dimitri Vordos
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  8. Andras Hoznek
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  9. Claude Clement Abbou
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  10. Laurent Salomon
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Corresponding author

Correspondence to Guillaume Ploussard.

Additional information

Olivier Alenda and Guillaume Ploussard contributed equally to this work.

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Alenda, O., Ploussard, G., Mouracade, P. et al. Impact of the primary Gleason pattern on biochemical recurrence-free survival after radical prostatectomy: a single-center cohort of 1,248 patients with Gleason 7 tumors. World J Urol 29, 671–676 (2011). https://doi.org/10.1007/s00345-010-0620-9

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  • DOI: https://doi.org/10.1007/s00345-010-0620-9

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