SURVIVAL AFTER RADICAL RETROPUBIC PROSTATECTOMY OF MEN WITH CLINICALLY LOCALIZED HIGH-GRADE CARCINOMA OF THE PROSTATE

Background. This study was performed to evaluate the efficacy of radic al prostatectomy for men with clinically localized, poorly differentia ted (Gleason score greater than or equal to 7) prostate cancer and to characterize further the prognostic significance of traditional pathol ogic variables. The effectiveness of adjuvant radiotherapy was assesse d in a subpopulation of men for whom the pathologic assessment suggest ed a high risk of persistent disease. Methods. Two hundred thirty-eigh t consecutive men, 74 of whom had clinically localized, poorly differe ntiated carcinoma, were followed for a median of 6.2 and 5.1 years, re spectively. The disease specific outcomes were derived from a non-pros tate specific antigen (PSA) screened population. Results. The 5-year d isease specific survival(DSS) for 52 men with a clinically localized G leason score of 7 and for 22 men with a Gleason score greater than or equal to 8 carcinoma was 92% and 79%, respectively. The 5-year likelih ood of having an undetectable PSA level was 50% for those with a Gleas on score of 7 and 38% for those with a Gleason score greater than or e qual to 8. Gleason score was the most powerful pathologic predictor of disease progression and survival. Pathologic stage was significantly associated with disease progression for carcinomas with Gleason scores less than 7 but was found to be less predictive of progression for ca rcinomas with Gleason scores greater than or equal to 7. Adjuvant radi otherapy provided a significantly reduced risk of PSA-detectable progr ession (P = 0.02, relative risk = 0.56, 95% CI: 0.34, 0.92); however, radiotherapy had no significant impact on DSS. Conclusions. Long term DSS is possible in a non-PSA screened series of men with poorly differ entiated prostate cancer treated by radical prostatectomy. These resul ts compare favorably with alternative treatment strategies, although t hey do illustrate a continued need to develop more effective adjuvant therapies for men with poorly differentiated prostate cancer.