I found an interesting case study from Henry Ford hospital in Michigan comparing Gleason 8 and Gleason 9 patients for biochemical recurrence after RRP. They concluded:
Despite comparable median ages, PSA levels, and clinical stages patients with Gleason 8 cancers were 1.7-fold more likely to have prostate-confined (pT2) tumours compared with seminal vesicle invasion (pT3b), patients with Gleason 9 disease were 3.6-fold more likely to harbour pT3b tumours compared with pT2. In Gleason 8–10 prostate cancer, patients with pT2 disease were previously shown to have the highest BCRFS [11,12]. Similarly, in the present study men with pT2 tumours had the highest BCRFS. Furthermore, in the present study pT3b cancers had a median BCRFS of only 6 months regardless of Gleason grade. In contrast, in the present study BCRFS in tumours exhibiting extraprostatic extension (pT3a) differed significantly between Gleason 8 and 9 cancers. The median BCRFS in pT3a tumours was not reached in Gleason 8 cancers while it was 13 months in Gleason 9 cancers (P= 0.007). If these findings are confirmed by other centres, it would be reasonable to recommend adjuvant therapy and enrolment in clinical trials for patients with Gleason 9 and pT3a tumours. All men with Gleason 8 or 9 tumours and seminal vesicle invasion would be recommended to undergo adjuvant treatment and strongly considered for enrolment in clinical trials. Conversely, patients with pT2 tumours are probably better managed expectantly. The differences in pathological stage distribution as well as potentially different biological behaviour of pT3a tumours may in part explain the different BCRFS rates between men with Gleason 8 and 9 tumours. Another possible factor in the better BCRFS of Gleason 8 compared with Gleason 9 tumours is TV. Gleason 9 tumours had significantly greater specimen TV compared with Gleason 8 (P < 0.001).
As previously reported in high Gleason grade tumours, in the present study surgical margin status was not a significant predictor of BCRFS on multivariable analysis despite the powerful significance of this tumour feature on univariate analysis [11,20]. Cautiously interpreted, this finding does not indicate that margin status is unimportant, rather, margin status is probably highly correlated with more statistically important pathological features such as Gleason grade, pathological stage and TV. Nonetheless, positive surgical margin status was associated with significantly worse BCRFS in Gleason 9 and not Gleason 8 cancers. This may suggest a different mechanism of BCR between patients with Gleason 8 and Gleason 9 disease in the current era. While micrometastatic disease probably plays a role in BCR for both Gleason 8 and 9 tumours, locally advanced disease may also have a prominent effect in Gleason 9 cancers. Patients with positive margins in the setting of Gleason 9 cancer should be strongly considered for adjuvant therapy regardless of pathological stage.
See: "Early oncological outcomes of robot-assisted radical prostatectomy for high-grade prostate cancer", http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2010.09484.x/full
It is an interesting read. Enjoy.
Age 59 Gleason 9
1/10 PSA 14.7
5/10 Bx: Gleason 3+4
8/4/2010 RRP: Gleason 4+5; Positive Margins, PNI
Incontinence: N/A; ED: 80% to the good
Until 4/11, PSA <.01; 4/11: .01; 6/11: .03
IADT3 begins 7/20; WPRT begins 8/22
Post Edited (Riviere) : 8/12/2011 9:37:51 AM (GMT-6)