Age, comorbidity, and the risk of prostate cancer-specific mortality in men with biopsy Gleason score 4+3: Implications on patient selection for multiparametric MRI - Abstract

BACKGROUND: Some men with biopsy Gleason score (GS) 7 prostate cancer (PC) harbor occult GS 8 to 10 PC and might be undertreated with short-term androgen deprivation therapy (ADT) and radiation therapy (RT).

With advancing age associated with occult high-grade PC, we evaluated PC-specific mortality (PCSM) risk after RT and short-term ADT for older men with GS 4+3 PC and men of any age with GS 8 to 10 PC.

PATIENTS AND METHODS: The study cohort comprised 206 men with unfavorable-risk PC treated with RT or RT and 6 months of ADT on a randomized trial between 1995 and 2001. Competing risks regression was used to compare PCSM risk for men with GS 8 to 10 PC to men with GS ≤ 3+4, GS 4+3 and age ≤ 73 years (median age), and GS 4+3 and age > 73 years, adjusting for PC risk factors, comorbidity, and treatment.

RESULTS: After a median follow-up of 14.3 years, 135 men died (65.53%), 24 (17.78%) of PC. Men age > 73 years with GS 4+3 PC did not have significantly lower PCSM risk compared with men with GS 8 to 10 (adjusted hazard ratio [AHR], 1.08; 95% confidence interval [CI], 0.29-4.06; P = .91); whereas unhealthy men (AHR, 0.20; 95% CI, 0.04-0.93; P = .04) and men age ≤ 73 years with GS 4+3 (AHR, 0.09; 95% CI, 0.01-1.03; P = .05) fared better.

CONCLUSION: Men age > 73 years with biopsy GS 4+3 did not have a significant difference in PCSM risk than men with GS 8 to 10, supporting further study of multiparametric magnetic resonance imaging in such men with no or minimal comorbidity before determining ADT duration.

Written by:
Chandra RA, Chen MH, Zhang D, Loffredo M, D'Amico AV.   Are you the author?
Harvard Radiation Oncology Program, Boston, MA; Department of Statistics, University of Connecticut, Storrs, CT; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.  

Reference: Clin Genitourin Cancer. 2015 Mar 17. pii: S1558-7673(15)00066-X.
doi: 10.1016/j.clgc.2015.03.001

PubMed Abstract
PMID: 25862319 Prostate Cancer Section