Gleason stratifications prognostic for survival in men receiving definitive external beam radiation therapy for localized prostate cancer - Abstract

PURPOSE: Histologic grade analyses for prostate cancer (PCa) have traditionally included Gleason scores (GS) of ≤ 6, 7, and 8-10. Stratified biochemical progression-free survival has increasingly been reported within these groups on analyses of primary-secondary patterns (PSPs) (e.g., 3+4 vs. 4+3) and overall GS (e.g., 8 vs. 9 vs. 10) but with limited data regarding stratified survival outcomes. In this analysis, outcomes for biopsy-assigned GS 6 to 10 were comprehensively evaluated to identify stratifications prognostic for survival in patients undergoing external beam radiation therapy (EBRT).

METHODS: The Surveillance, Epidemiology, and End Results database was examined for T1-4 N0 M0, GS 6 to 10 PCa managed with EBRT alone from 2004 to 2006. GS and PSP variations were analyzed for PCa-specific survival (PCSS) and overall survival (OS).

RESULTS: Overall, 26,885 patients were evaluated. Preliminary PSP analyses identified stratifications for 3+4 vs. 4+3 = 7 and 4+4 = 8 vs. GS 8 with pattern 5 (P5) (i.e., 3+5 and 5+3) as significant; however, no differences were observed for 4+5 vs. 5+4 = 9. The primary analysis included stratifications for GS 6, 3+4, 4+3, 4+4, 8 w/P5, 9, and 10, where the 7.5-year PCSS rates were 99%, 97%, 95%, 91%, 86%, 81%, and 78% and 7.5-year OS rates were 83%, 76%, 72%, 67%, 66%, 58%, and 54%, respectively. PCSS differences for sequential score increases were all significant on univariate analyses (all P< 0.05). In sequential multivariate analyses of PCSS accounting for age, prostate-specific antigen, T stage, year, marital status, race, and tumor registry, the identified GS stratifications remained significant (all P< 0.05), with the exception of GS 8 w/P5 vs. 9 (P = 0.11). In overall multivariate analyses, the identified GS stratifications represented the strongest prognostic factor for survival. Subgroup analyses demonstrated that presence of any P5 was an independent prognostic factor for survival.

CONCLUSION: In the largest reported survival analysis of Gleason stratifications, biopsy-assigned GS 6, 3+4, 4+3, 4+4, 8 w/P5, 9, and 10 represented sequential prognostic factors for survival in patients managed with definitive EBRT.

Written by:
Rusthoven CG, Waxweiler TV, DeWitt PE, Flaig TW, Raben D, Kavanagh BD.   Are you the author?
Department of Radiation Oncology, University of Colorado-Denver, Aurora, CO; Department of Biostatistics and Informatics, University of Colorado-Denver, Aurora, CO; Department of Medical Oncology, University of Colorado-Denver, Aurora, CO.

Reference: Urol Oncol. 2014 Aug 20. pii: S1078-1439(14)00266-X.
doi: 10.1016/j.urolonc.2014.07.010


PubMed Abstract
PMID: 25151595

Go "Beyond the Abstract" - Read an article written by the authors for UroToday.com

UroToday.com Prostate Cancer Section

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe