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Gleason Score Can Help Identify Prostatectomy Patients Who May Benefit from Salvage Radiotherapy

The Gleason score, which is commonly used in assessing prostate cancer biopsies, can help identify radical prostatectomy patients who may benefit from salvage radiotherapy following biochemical recurrence.

The benefit of salvage radiotherapy for prostate-specific antigen (PSA) recurrence following radical prostatectomy (RP) has been documented by numerous investigators, although their results have been conflicting.

Researchers led by Michaël Peyromaure, MD, at the Cochin Hospital's Department of Urology, in Paris, France, reported the results of a 10-year study that may help clinicians in deciding whether their prostatectomy patients may benefit from salvage radiotherapy.

The researchers followed 62 patients, who were treated with radiotherapy at a dose of 65 GY after they experienced PSA recurrence following radical prostatectomy. The investigators calculated the risk of PSA recurrence following radiotherapy by analysing 10 factors: patient age, pre-prostatectomy PSA level, pathologic stage, Gleason score, surgical margin status, PSA nadir after prostatectomy, time to PSA recurrence after prostatectomy, pre-radiotherapy PSA level, PSA nadir after radiotherapy, and length of follow-up after radiotherapy.

During the mean follow-up of 44 months, 37% of the patients experienced PSA recurrence, the authors reported. Using a univariate analysis, they found 6 factors that were predictive of PSA recurrence; but only two were predictive based on a multivariate analysis - the patient's Gleason score and the length of follow-up after radiotherapy. "More than 75% of the patients with Gleason score greater than 7 and a follow-up longer than 3 years had experienced PSA recurrence at the time of analysis," they reported.

The predictive value of the Gleason score has been observed by previous investigators, the authors noted. "These findings suggest that patients experiencing a rising PSA level after RP with a Gleason score of 8 or greater are likely to have systemic disease and may not, therefore, benefit from RT," they added. "However, our study was small and needs to be confirmed by larger cohorts with more prolonged follow-up."


Urology 2003 Sep;62:3:503-7. "Salvage radiotherapy for biochemical recurrence after radical prostatectomy: a study of 62 patients"

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