RADICAL PROSTATECTOMY FOR ADENOCARCINOMA OF THE PROSTATE - THE INFLUENCE OF PREOPERATIVE AND PATHOLOGICAL FINDINGS ON BIOCHEMICAL DISEASE-FREE OUTCOME

Objective. This retrospective study evaluated the outcome for a cohort of men undergoing radical retropubic prostatectomy alone as primary t reatment for clinical T1-2 prostate adenocarcinoma. Methods. Sixty-two patients treated at Boston University Medical Center between 1987 and 1992 underwent radical prostatectomy alone without adjuvant or neoadj uvant endocrine therapy. Actuarial and multivariate analyses were made of disease-free outcome according to preoperative tumor T stage, pros tate-specific antigen (PSA), and biopsy grade, and according to the pa thologic findings at surgery. Recurrence was defined as the persistenc e or recurrence of detectable serum PSA four or more weeks following s urgery. Results. Of all patients judged clinically to have localized d isease (T1-2), 52 percent proved to have pathologic T3 tumors. Of thes e, 81 percent had positive surgical margins. The strongest preoperativ e predictors of pT3 disease were the biopsy Gleason grade and the init ial serum PSA value. Actuarial analysis showed the overall likelihood of remaining free from detectable PSA at four years to be 43 percent ( 75% for those with organ-confined disease and 27% for those who were p T3). The poorest prognosis was seen in those with seminal vesicle invo lvement. Biopsy Gleason grade and initial PSA were independent preoper ative predictors of biochemical failure in a Cox regression analysis b ut clinical T stage was not. Conclusions. The biopsy Gleason grade and initial PSA were identified as strong preoperative predictors of dise ase-free outcome. We confirmed the favorable prognosis of men with org an-confined disease, but emphasize the high likelihood of relapse in t hose with positive surgical margins or seminal vesicle invasion.