OBJECTIVES: Most adenocarcinomas of the prostate with a Gleason score greater 
than 8 at radical prostatectomy have extraprostatic extension and a high risk of 
progression. With prostate-specific antigen screening, we have seen some cases 
of earlier detected, organ-confined, high-grade adenocarcinoma. Few data are 
available as to the likelihood of cure in these cases.
METHODS: We reviewed 27 cases of pathologically organ-confined adenocarcinoma 
with a prostatectomy Gleason score of 8 to 10. To exclude cases with a 
significant proportion of Gleason pattern 3, we excluded cases of Gleason score 
3+5=8 and Gleason score 5+3=8. All cases of Gleason score 8 at radical 
prostatectomy were Gleason score 4+4. The prognostic value of the clinical 
parameters (clinical stage, serum prostate-specific antigen level, age) and 
pathologic factors (biopsy Gleason score, radical prostatectomy Gleason score, 
prostatectomy tumor volume) were tested to predict postoperative progression.
RESULTS: The mean age at diagnosis was 59.7 years (range 46 to 69) with 
preoperative serum prostate-specific antigen levels ranging from 1.4 to 28 ng/mL 
(mean 7.8). All tumors were classified as pathologic Stage T2N0Mx. Fifteen 
patients (55.6%) had a Gleason score of 8, 11 patients (40.7%) had a Gleason 
score of 9, and 1 had a Gleason score of 10 (3.7%). Tumor volumes ranged from 
0.02 to 1.44 cm(3) (mean 0.56). Follow-up information was available for all men. 
The mean follow-up for those without progression was 30.6 months (range 7 to 73) 
and for those with progression was 23.6 months (range 9 to 44). The 33-month 
actuarial risk of progression was 32%, with 10 men developing progression during 
the study. None of the preoperative or postoperative variables predicted 
progression.
CONCLUSIONS: Even when high-grade tumor is organ confined, it is associated with 
a relatively unfavorable short-term outcome that is not predictable on the basis 
of either preoperative clinicopathologic data or postoperative pathologic 
information obtained from the radical prostatectomy specimen.