Prediction of Extraprostatic Extension in Men With Biopsy Gleason Score of 8 or Greater

Purpose: Recent data have shown that high grade prostate cancer is a potentially surgically curable disease in properly selected patients. We assessed the ability of preoperative variables to predict extraprostatic extension in men with biopsy Gleason score 8 or greater. Materials and Methods: We identified 159 patients who underwent prostatectomy without neoadjuvant therapy for biopsy proven Gleason score 8 or greater T1c-T2N0M0 cancer between 1996 and 2006. Univariate and multivariate analyses were performed to predict extraprostatic extension using side specific data, including clinical features and biopsy findings. Results: Organ confined cancer was pathologically confirmed in 84 of 159 patients (52.8%). Side specific analysis was practicable on 124 sides (124 men) and side specific extraprostatic extension was found on 48 of the 124 sides (38.7%). Gleason grade 5 element, maximum tumor length, percent of positive cores, positive basal cores and side specific palpable disease were significantly associated with side specific extraprostatic extension. On multivariate analysis maximum tumor length and a positive basal core were independent predictors of side specific extraprostatic extension (p <0.001 and 0.033, respectively). When maximum tumor length was less than 7 mm and the basal core was negative for cancer, the incidence of side specific extraprostatic extension was low (2 of 35 cases or 5.7%). In contrast, the risk of side specific extraprostatic extension was 56.8% (25 of 44 cases) when maximum tumor length was 7 mm or greater and the basal core was positive for cancer. Conclusions: Applying our criteria for prostatectomy could significantly decrease the risk of inadequate cancer control and increase the probability of maintaining potency in patients with prostate cancer with biopsy Gleason score 8 or greater.