Radical Prostatectomy for High Grade Disease: A Reevaluation 1994

Traditionally, patients with high grade tumors (Gleason score 8 to 10) were not considered candidates for radical prostatectomy because of poor long-term survival rate. However, with improvements in the staging of prostate cancer and a reduction in the morbidity of radical prostatectomy, it is reasonable to reevaluate the results of radical prostatectomy in high grade disease in a contemporary setting. We studied the clinical outcome of 72 men with Gleason scores 8 to 10 on needle biopsy who presented with clinically localized disease (T1c [9], T2a [22], T2b [17], T2c [13] and T3a [11]). Nine patients (13%) did not undergo radical prostatectomy because of positive lymph nodes identified on frozen section. Of the 63 men who underwent radical prostatectomy 43 (68%) had negative lymph nodes and 20 (32%) had positive lymph nodes. The actuarial likelihood of having an undetectable serum prostate specific antigen at 5 years was 43% for men with negative lymph nodes and 45% for men with specimen confined disease. In 7 men (9%) distant metastases developed and all had positive lymph nodes at surgery. These data suggest that men with high grade disease who are suitable candidates for radical prostatectomy should have the pelvic lymph nodes evaluated. If the lymph nodes are negative, the patient may benefit from an attempt at surgical cure.