Prostate-specific antigen level, stage or Gleason score: which is best for predicting outcomes after radical prostatectomy, and does it vary by the outcome being measured? Results from Shared Equal Access Regional Cancer Hospital database

UMMS Affiliation

School of Medicine; Senior Scholars Program

Faculty Mentor

Stephen Freedland (Duke University)

Publication Date


Document Type



Aged; Databases, Factual; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Predictive Value of Tests; Proportional Hazards Models; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Prostatic Neoplasms, Castration-Resistant; Retrospective Studies; Treatment Outcome


Health Services Research | Neoplasms | Urology


OBJECTIVES: To assess the ability of preoperative prostate-specific antigen level, Gleason score and stage to predict prostate cancer outcomes beyond biochemical recurrence, specifically castration-resistant prostate cancer, metastases and prostate cancer-specific mortality in radical prostatectomy patients.

METHODS: We carried out a retrospective study of 2735 men in the Shared Equal Access Regional Cancer Hospital database treated by radical prostatectomy from 1988 to 2011 with data available on pathological stage, grade and preoperative prostate-specific antigen. We used Cox hazards analyses to examine the predictive accuracy (c-index) of the preoperative prostate-specific antigen (log-transformed), path Gleason score ( < /= 7, 3 + 4, 4 + 3 and 8-10) and path stage grouping (pT2 negative margins; pT2 positive margins; pT3a negative margins; pT3a positive margins; pT3b; vs positive nodes) to predict biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality.

RESULTS: Median follow up was 8.7 years, during which, 937 (34%) had biochemical recurrence, 108 (4%) castration-resistant prostate cancer, 127 (5%) metastases and 68 (2%) prostate cancer-specific mortality. For the outcomes of biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality, the c-indices were, respectively: prostate-specific antigen 0.65, 0.66, 0.64 and 0.69; Gleason score 0.66, 0.83, 0.76 and 0.85; and pathological stage group 0.69, 0.76, 0.72 and 0.80.

CONCLUSIONS: Gleason score can predict with very high accuracy prostate cancer-specific mortality in patients undergoing radical prostatectomy. Thus, Gleason score should be given more weight in nomograms to predict prostate cancer-specific mortality. Furthermore, men with a high Gleason score should be given special consideration for adjuvant treatment or referral to clinical trials because of a higher risk of prostate cancer-specific mortality.


disease progression, mortality, prostatectomy, prostatic neoplasms, risk factors

DOI of Published Version



Int J Urol. 2015 Apr;22(4):362-6. doi: 10.1111/iju.12704. Epub 2015 Feb 24. Link to article on publisher's site

Journal/Book/Conference Title

International journal of urology : official journal of the Japanese Urological Association


Prabhakar Mithal participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

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