PURPOSE: To examine the differences in outcome in patients with biopsy Gleason score 8 versus 9-10 who received definitive local therapy.
PATIENTS AND METHODS: Using an institutional database, we identified a cohort of 847 patients with biopsy Gleason 8-10 disease who received definitive local therapy with radiation therapy (RT) or radical prostatectomy (RP) between January 2001 and December 2011. Multivariable Cox modeling assessed the association of Gleason score of 8 versus Gleason 9-10 with time to biochemical recurrence, time to metastases, and overall survival, and test for treatment by Gleason score interaction. Median follow-up of the cohort was 5.3 years.
RESULTS: Baseline patient characteristics were similar between biopsy Gleason 8 versus 9-10. Gleason 9-10 disease was associated with higher PSA at diagnosis; for local therapy they were also more likely to have received RT (58% vs. 46%, p=0.001) and neoadjuvant/adjuvant androgen deprivation therapy (64% vs. 49%, p< 0.001). Those with higher-grade disease had increased risk of developing metastatic disease (HR=1.41, 95%CI: 1.11-1.79). There is a trend toward increased risk of death (HR=1.28, 95%CI: 0.98-1.66) in Gleason 9-10 compared to those with Gleason 8 cancer, with increased risk of death for patients with Gleason 9-10 mainly observed in patients treated with RP whether or not they received additional RT (HR=1.74, 95%CI: 1.15-2.65).
CONCLUSION: Patients with localized biopsy Gleason 9-10 disease treated with definitive local therapy had worse outcomes compared to patients diagnosed with biopsy Gleason 8 disease. Clinical trials incorporating newer approaches to Gleason 9-10 cancer are urgently needed.
Written by:
Tsao CK, Gray KP, Nakabayashi M, Evan C, Kantoff PW, Huang J, Galsky MD, Pomerantz M, Oh WK. Are you the author?
Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Pathology, David Geffen School of Medicine at University California Los Angeles, Los Angeles, CA.
Reference: J Urol. 2015 Jan 23. pii: S0022-5347(15)00168-8.
doi: 10.1016/j.juro.2015.01.078
PubMed Abstract
PMID: 25623747