Gleason Pattern 5 is a Possible Pathologic Predictor for Biochemical Recurrence after Laparoscopic Radical Prostatectomy

Abstract

Objective: Several prognostic factors for biochemical recurrence after radical prostatectomy have been reported,<br />including initial prostate-specific antigen level, Gleason score, positive surgical margin, and seminal vesicle invasion.<br />Here we investigate whether Gleason pattern 5 is a predictor for biochemical recurrence. Methods: This retrospective<br />study included 168 patients who underwent laparoscopic radical prostatectomy from 2006 to 2015. The relationship<br />between biochemical recurrence after laparoscopic radical prostatectomy and the presence of Gleason pattern 5, even<br />as a tertiary pattern, was investigated. Biochemical recurrence was defined when the prostate-specific antigen level<br />rose to >0.2 ng/ml after having decreased to recurrence-free survival was estimated by the Kaplan-Meier method. Multivariate analysis was performed using a<br />Cox proportional hazards regression model. Results: The median age was 66 years, median initial prostate-specific<br />antigen level was 6.9 ng/ml, and median follow-up period was 47.3 months. Biochemical recurrence was recognized<br />in 27 patients (16.1%) after laparoscopic radical prostatectomy, and 5-year biochemical recurrence-free survival was<br />78.6%. Gleason pattern 5 was noted in 5 patients as the primary pattern, in 10 as the secondary pattern, and in 5 as the<br />tertiary pattern. According to multivariate analysis, presence of Gleason pattern 5 (HR = 4.75, p=0.001) and positive<br />surgical margin (HR = 4.66, p=0.001) were independent predictive factors for biochemical recurrence-free survival.<br />Conclusion: Gleason pattern 5 appears to be an important predictive factor for biochemical recurrence after laparoscopic<br />radical prostatectomy.