Long-term outcome following radical prostatectomy for Gleason 8-10 prostatic adenocarcinoma

Compared to low-grade disease, high-grade prostate cancers exhibit a higher rate of disease progression. As a result, there has been a trend to treat high-risk disease with methods other than surgery. The purpose of this study is to evaluate the long-term survival following radical prostatectomy (RRP) for non-metastatic Gleason 8-10 prostate adenocarcinoma (CaP).

All patients 75 years or less with Gleason 8-10 CaP that underwent RRP were identified from the SEER 18 database. Patients with metastatic disease, those who underwent other modalities of treatment, or with more than one primary cancer, were excluded. Data were analyzed for demographics, stage at presentation, treatment modality, and overall survival and cancer-specific survival.

A total of 30,379 men met inclusion criteria. Mean age was 62.5 years and 82.5 % of patients were white. A total of 52.8 % of patients had T2 disease, and 73.1 % had node-negative disease, 80.2 % of patients underwent pelvic lymph node dissection, and 12.9 % underwent adjuvant radiation therapy. Overall survival for the entire cohort was 92.8, 78.6, 59.5, 38.6, and 20.0 % for 5, 10, 15, 20, and 25 years, respectively. Cancer-specific survival was 96.4, 89.5, 82.0, 72.9, and 68.8 % for 5, 10, 15, 20, and 25 years, respectively.

Although historically underutilized in patients with poorly differentiated disease, radical prostatectomy provides excellent long-term survival and should be offered to healthy patients.