PROGRESSION AND SURVIVAL IN PROSTATIC ADENOCARCINOMA - A COMPARISON OF CLINICAL STAGE, GLEASON GRADE, S-PHASE FRACTION AND DNA-PLOIDY

Clinical data were reviewed in 325 patients with prostatic adenocarcinoma followed up for a mean of 13 years. Paraffin-embedded tumour biopsy specimens from the primary rumours were available for Bow cytometry (FCM) in 273 cases. Intra-tumour heterogeneity in DNA index (DI) was found in 4% of the tumours (54 cases were analysed). S-phase fraction (SPF) and DNA ploidy were significantly interrelated. Aneuploidy and high SPF were significantly related to both a high T category and high Gleason score. The progression in T1-2M0 tumours was related to Gleason score (P=0.009), DNA ploidy (P=0.006) and SPF (P=0.007), while the Gleason score (P=0.0013), DNA ploidy (P=0.002) and SPF (P<0.001) had prognostic value in univariate survival analysis. In the entire cohort, the T category (P<0.001), M category (P<0.001), Gleason score (P<0.001), DNA ploidy (P<0.001) and SPF (P<0.001) were significant prognostic factors. In Cox's analysis, the M category (P<0.001), Gleason score (P<0.001), T category (P=0.003), age (P=0.001) and SPF (P=0.087) were independently related to prognosis. In the T1-2M0 tumours, Gleason score (P<0.001), T category (P=0.022) and SPF (P=0.058) were independent predictors. A novel classification system in which the DNA ploidy or SPF and the Gleason score were combined was found to be of significant prognostic value in all MO tumours (P<0.001). The results suggest that FCM can be used as an adjunct to conventional histological assessments for determination of the correct prognostic category in prostatic adenocarcinoma.