Gleason 6 prostate tumors diagnosed in the PSA era do not demonstrate the capacity for metastatic spread at the time of radical prostatectomy

Nicholas M. Donin, Juliana Laze, Ming Zhou, Qinghu Ren, Herbert Lepor

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Objective: To elucidate the probability that Gleason 6 tumors diagnosed in the prostate-specific antigen (PSA) era treated with radical prostatectomy (RP) develop metastasis. Methods: Between October 2000 and June 2012, 1781 men underwent open RP by a single surgeon. Biochemical recurrence (BCR) was defined as a serum PSA value ≥0.2 ng/mL, or 2 progressively rising PSA values >0.14 ng/mL. Significant BCR (sBCR) was defined as a BCR with a PSA doubling time (PSADT) <36 months. Insignificant BCR (iBCR) was defined as BCR with a PSADT ≥36 months. Results: Eight hundred fifty-seven of men (48.1%) undergoing open RP had a pathologic diagnosis of Gleason 6. Twenty-three of 857 of these men (2.7%) developed BCR, 7 were designated as iBCR (mean PSADT 81 months, range 36 to 100), 16 were sBCR (mean PSADT 8 months, range 1.5-20 months). There was a 10-fold difference in PSADT between the sBCR and iBCR groups (P <.001). All men with sBCR underwent salvage radiation therapy (SRT) and all demonstrated a subsequent PSA decline to ≤0.1 ng/mL, suggesting all men had local recurrence. Two men (0.23%) developed a BCR after salvage radiation therapy, both of whom were found to have Gleason 7 disease after pathologic re-review. Conclusion: In our large cohort of men with pathological Gleason 6 disease undergoing open RP, sBCR were attributable exclusively to local disease recurrences. Our findings support the conclusion that Gleason 6 disease exhibits a very low capacity for metastatic spread.

Original languageEnglish (US)
Pages (from-to)148-153
Number of pages6
JournalUrology
Volume82
Issue number1
DOIs
StatePublished - Jul 2013

ASJC Scopus subject areas

  • Urology

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