Recurrent Gleason Score 6 Prostate Cancer After Radiotherapy or Ablation: Should We Observe Them All? Results from a...

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Salvage radical prostatectomy (sRP) for recurrent prostate cancer (PCa) often leads to poor functional outcomes and high complication rates.
• Gleason score (GS) 6 PCa is characterized by minimal metastatic potential.
• The behavior of GS 6 PCa recurring after non-surgical treatments like radiotherapy or ablation remains understudied.

Purpose of the Study:

• To evaluate the oncological outcomes of sRP for patients with Gleason score 6 prostate cancer recurring after non-surgical primary treatments (radiotherapy and/or ablation).

Main Methods:

• A retrospective analysis of sRP cases for recurrent PCa post-local non-surgical treatment was conducted across 14 tertiary referral centers (2000-2021).
• Data included prostate biopsy and sRP histology for GS 6 PCa.
• Survival analysis (metastasis, cancer-specific survival, overall survival) and concordance assessment between biopsy and sRP pathology were performed.

Main Results:

• The study analyzed two cohorts: GS 6 PCa at pre-sRP biopsy (n=142) and at sRP (n=50).
• 10-year metastasis rates for biopsy GS 6 were 79%, with 98% cancer-specific survival and 89% overall survival.
• Significant upgrading at sRP occurred in 69% of cases, with 35.5% pT3 stage and 13.4% positive nodes; sRP GS 6 showed 100% metastasis-free survival but high complication rates (>50% overall, >10% high-grade).

Conclusions:

• GS 6 PCa recurring after non-surgical treatment demonstrates minimal metastatic potential, but sRP is associated with significant morbidity.
• A substantial proportion of pre-sRP biopsies misclassify GS 6 PCa, with frequent upgrading upon surgical resection.
• Enhancing the diagnostic accuracy of pre-sRP biopsies is essential to prevent overtreatment of GS 6 PCa.