Natural history of pathologically organ-confined (pT2), Gleason score 6 or less, prostate cancer after radical prostatectomy

OBJECTIVES Men with pathologically organ-confined, Gleason score 6 or less prostate cancer are considered to have an excellent prognosis after surgery as definitive monotherapy. We determined the incidence of biochemical recurrence (BR), local recurrence (I-R), distant metastasis (DM), and prostate cancer-specific mortality (PCSM) among this low-risk cohort. METHODS A retrospective search of our radical prostatectomy database identified 6081 men with pathologically organ-confined (pT2), Gleason score 6 or less prostate cancer treated from 1983 to 2005. Of these, 2551 (42%) had adequate follow-up information and were assessed for BR, LR, DM, and PCSM. The pathologic specimens of men with disease progression were reevaluated by an experienced genitourinary pathologist, and the patients with disease that was upgraded or upstaged (n = 25) were excluded from additional analysis, resulting in a final study cohort of 2526. The actuarial probabilities of BR and LR were estimated using the Kaplan-Meier method. RESULTS With a median follow-up of 5.0 years (range 2 to 22), BR occurred in 13 patients (0.5%). The 5, 10, and 15-year actuarial probability of BR was 0.3%, 0.9%, and 1.3%, respectively. Five patients (0.2%) developed LR, four of whom received salvage radiotherapy with a subsequently undetectable prostate-specific antigen level. The 5, 10, and 15-year actuarial probability of LR was 0.1%, 0.5%, and 0.5%, respectively. No DM or PCSM occurred. CONCLUSIONS With postoperative follow-up for more than 2500 patients with pathologically organ-confined, Gleason score 6 or less prostate cancer, BR and LR after radical prostatectomy were extremely rare, and no patients experienced DM or PCSM.