Prediction of extraprostatic extension in men with biopsy Gleason score of 8 or greater.

Abstract

Recent data have shown that high grade prostate cancer is a potentially surgically curable disease in properly selected patients. We assessed the ability of preoperative variables to predict extraprostatic extension in men with biopsy Gleason score 8 or greater. We identified 159 patients who underwent prostatectomy without neoadjuvant therapy for biopsy proven Gleason score 8 or greater T1c-T2N0M0 cancer between 1996 and 2006. Univariate and multivariate analyses were performed to predict extraprostatic extension using side specific data, including clinical features and biopsy findings. Organ confined cancer was pathologically confirmed in 84 of 159 patients (52.8%). Side specific analysis was practicable on 124 sides (124 men) and side specific extraprostatic extension was found on 48 of the 124 sides (38.7%). Gleason grade 5 element, maximum tumor length, percent of positive cores, positive basal cores and side specific palpable disease were significantly associated with side specific extraprostatic extension. On multivariate analysis maximum tumor length and a positive basal core were independent predictors of side specific extraprostatic extension (p <0.001 and 0.033, respectively). When maximum tumor length was less than 7 mm and the basal core was negative for cancer, the incidence of side specific extraprostatic extension was low (2 of 35 cases or 5.7%). In contrast, the risk of side specific extraprostatic extension was 56.8% (25 of 44 cases) when maximum tumor length was 7 mm or greater and the basal core was positive for cancer. Applying our criteria for prostatectomy could significantly decrease the risk of inadequate cancer control and increase the probability of maintaining potency in patients with prostate cancer with biopsy Gleason score 8 or greater.