Prognostic value of the Gleason score in prostate cancer

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Abstract
Objective To investigate the prognostic value of the Gleason score in prostate cancer. Patients and methods A consecutive series of 305 men with prostate cancer diagnosed at transurethral resection (1975–1990) and with no curative treatment was analysed. There was no assessment of prostate‐specific antigen level during this period. The mean (range) age at diagnosis was 73.7 (52–95) years and the mean follow‐up was 6.4 (0–22) years. The influence of Gleason score and the percentage of the specimen area with tumour (% cancer) on disease‐specific survival were assessed using Kaplan–Meier analyses. Results Of 305 cancers, 22% had a Gleason score of 4–5, 29% of 6, 18% of 7 and 32% of 8–10. At the follow‐up, 89% of the men had died, of whom 42% had died from prostate cancer. The disease‐specific 10‐year survival was 56%. The disease‐specific mean survival (DSMS) for Gleason score 4–5, 6, 7 and 8–10 was 20, 16, 10 and 5 years, respectively ( P < 0.001). The DSMS did not differ significantly between Gleason 4 and 5 or between 8–10. There was a trend towards shorter survival for Gleason 4 + 3=7 (DSMS 9 years) than GS 3 + 4=7 (DSMS 13 years; P = 0.16). Gleason score and % cancer were independent predictors of DSMS ( P < 0.001). Conclusion The long‐term prognosis of prostate cancer on deferred treatment is predicted well by the Gleason score. Four prognostic categories of prostate cancer are suggested, i.e. Gleason score 4–5, 6, 7 and 8–10.

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