Prognostic factors in men with stage D1 prostate cancer: identification of patients less likely to have prolonged survival after radical prostatectomy.

The role of radical prostatectomy in the management of stage D1 disease is controversial. Although cure is unlikely, some men survive for long intervals apparently free of metastatic disease. For this reason, effective palliation of the local lesion is desirable in men who will live long enough to benefit. In an effort to identify factors that correlated with interval to progression to distant metastases, we studied 113 men with stage D1 disease who underwent radical prostatectomy between 1974 and 1991. Progression of disease to distant metastases did not independently correlate with the size of the nodal metastases, number of positive lymph nodes or bilaterality of lymph node metastases. Only high Gleason score (8 to 10) on the preoperative biopsy correlated with rapid progression to distant metastases (p < or = 0.00001) in a multivariate analysis. If the Gleason score was less than 8, the likelihood of distant metastases was only 18% and 41% at 5 and 10 years, respectively, whereas 85% of men with a Gleason score of 8 to 10 had distant metastases by 5 years. For urologists who believe that radical prostatectomy is useful in providing local control in men with positive lymph nodes, frozen section analysis of lymph nodes is probably not necessary in men who are candidates for radical prostatectomy and have preoperative Gleason scores of less than 8. Conversely, in patients with a Gleason score of 8 to 10 on needle biopsy, careful analysis of lymph nodes is necessary to avoid radical prostatectomy in those who will derive little benefit.