Adenocarcinoma of the prostate with Gleason score 9-10 on core biopsy: Correlation with findings at radical prostatectomy and prognosis

Purpose: There is a paucity of data on the prognosis after radical prostatectomy for Gleason score 9-10 disease on needle biopsy. To our knowledge we report the largest study to date to specifically analyze the correlation of Gleason score 9-10 on needle core biopsy with radical prostatectomy outcomes. Materials and Methods: We identified 259 men with Gleason score 9-10 on biopsy who underwent radical prostatectomy from 1987 to 2012 at our institution. Preoperative variables analyzed were age, race, preoperative prostate specific antigen, adenocarcinoma site, perineural invasion, number of total biopsy cores, number of total positive cores, number of positive cores with Gleason score 9-10, maximum percent of core length with Gleason score 9-10 and maximum percent of adenocarcinoma overall. We determined pathological outcomes on univariate and multivariate analysis, including organ confinement, seminal vesicle invasion, margin status, lymph node metastasis, and biochemical-free and cancer specific survival. Results: Statistically significant predictors of radical prostatectomy outcome were organ confinement (total cores with Gleason score 9-10, maximum percent overall and perineural invasion), margin status (preoperative prostate specific antigen and clinical stage), seminal vesicle invasion (maximum percent overall, perineural invasion and clinical stage), lymph node metastasis (total number of cores with Gleason score 9-10 and clinical stage) and biochemical-free survival (maximum percent of Gleason score 9-10, maximum percent overall and clinical stage) (each p <0.05). Conclusions: In the highly select subset of patients who are good surgical candidates and have the appropriate combination of preoperative variables postoperative findings are sufficiently favorable to justify radical prostatectomy.