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Patients with Gleason score 8-10 prostate cancer are, in part, still considered to be less suitable candidates for radical prostatectomy (RPE) as primary therapy due to high relapse rates and low tumorspecific survival. This study aimed to analyze tumorspecific survival and biochemical progression-free survival (bNED) in patients with Gleason score 8-10 prostate cancer following RPE. For reasons of comparison patients with Gleason score 7 prostate cancer were also enclosed in the study.
Overall, 489 patients out of two patient collectives from the two German University Hospitals Marburg (n=106) and Cologne (n=383) were observed with a mean follow up time of 23.1 ± 14.7 months. 415 patients (84.9%) had a postoperative Gleason score of 7, 32 (6.5%) and 42 patients (8.6%) a postoperative Gleason score of 8 and 9/10, respectively. 53.3% of the studied patients (mainly those with a pN+ status and/or tumors ≥ pT3b) underwent additional adjuvant therapies (ADT, radiation, others). Tumorspecific survival and bNED were calculated by means of Kaplan-Meier method/log rank test.
Tumorspecific overall survival was 96.3% (5 patients died) and bNED was 54.5% (71 patients showed a PSA-relapse). 243 patients (49.7%) were diagnosed with a pT2 tumor, 237 (48.5%) and 9 patients (1.8%) with a pT3 and pT4 tumor, respectively. Patients with tumors < pT3b showed a tumorspecific survival of 99.4%. Interestingly, in this subgroup there were no Gleason score-related differences in regard to tumorspecific survival. Preoperative PSA and pN status barely missed significance as prognostic factors. Our data suggest RPE to represent a reasonable primary therapy for patients with high risk localized prostate cancer. Further progressed forms of this cancer require multimodal therapy concepts. Extended follow-up times and a larger amount of study patients are needed to confirm these results and reveal additional prognostic factors.