Disease-specific death and metastasis do not occur in patients with Gleason score ≤6 at radical prostatectomy

OBJECTIVES To assess metastasis-free survival (MFS) and diseasespecific survival (DSS) in men with Gleason score <= 6 prostate cancer at radical prostatectomy (RP). PATIENTS AND METHODS We included 1101 consecutive RP patients operated between March 1985 to July 2013 at a single institution. The outcome variables were IVIFS and DSS. The postoperative survival was estimated by the Kaplan Meier method. RESULTS The Gleason score distribution of the study population (1101 patients) was Gleason score <= 6 (449, 41%), Gleason score 3 + 4 = 7 (436, 40%), Gleason score 4 + 3 = 7 (99, 9%) and Gleason score 8-10 (117, 11%). The median (interquartile range) postoperative follow-up was 100 (48-150) months. During follow-up 197 men (18%) died, of whom 42 (3.8%) died from prostate cancer-related causes. In all, 19/1101 patients (1.7%) had documented lymph node metastasis at the time of RP: none with Gleason score <6, seven with Gleason score 3 + 4 = 7 (1.6%), six with Gleason score 4 + 3 = 7 (6.1%) and six with Gleason score 8-10 (5.1%). Distant metastasis occurred in 56/1101 patients (5.1%): none with Gleason score <6, 23 with Gleason score 3 + 4 = 7 (5.3%), 17 with Gleason score 4 + 3 = 7 (17%) and 16 with Gleason score 8-10 (14%). Disease-specific death, stratified per Gleason-score group was: none in <6, 16 (3.7%) in 3 + 4 7, 16 (16%) in 4 + 3 = 7 and 10 (8.5%) in 8-10 group. CONCLUSION No metastasis or disease-specific death were seen in rnen with Gleason score <6 prostate cancer at RP, showing the negligible potential to metastasise in this large subgroup of patients with prostate cancer.