The Need for More Aggressive Therapy for Men with Gleason 9-10 Disease Compared to Gleason ≤8 High-Risk Prostate Cancer. Issue 2 (March 2016)

• Record Type: Journal Article
• Authors: Safdieh, Joseph J.; Schwartz, David; Weiner, Joseph P.; Nwokedi, Emmanuel; Schreiber, David
• Is Part Of: Tumori. Volume 102:Issue 2(2016)
• Page Start: 168
• Page End: 173
• Publication Date: 2016-03
• Subjects: External beam radiation -- Gleason 9-10 -- High-risk prostate cancer; Cancer -- Periodicals; 616.994
• DOI: 10.5301/tj.5000475
• Languages: English
• ISSNs: 0300-8916

Abstract

Purpose: To evaluate the outcomes of prostate cancer patients with high-risk disease stratified by Gleason Score (GS) (GS ≤8 vs GS ≥9) treated with external beam radiotherapy (EBRT). Methods: The medical records of patients who underwent EBRT between 2003 and 2011 and had nonmetastatic high-risk disease were analyzed retrospectively. Patients were treated with EBRT and all patients received a dose ≥7, 560 cGy. Androgen deprivation therapy was given in most patients (90%). Results: A total of 155 patients were identified (GS ≤8 n = 104, GS ≥9 n = 51), and they had a median presenting prostate-specific antigen (PSA) of 14.7 ng/mL. At a median follow-up of 69 months, the 7-year biochemical failure-free survival was 59.1% in those with GS ≥9 and 69.2% in those with GS ≤8 (p = 0.12). On MVA, Gleason 9-10 (HR 1.83, p = 0.08) was not associated with an increased risk of biochemical recurrence, while a PSA >20 ng/mL (HR 2.39, p = 0.04) was associated with an increased likelihood of biochemical recurrence. Patients with GS ≥9 were noted to have worse 7-year distant metastatic-free survival (79.6% vs 90.5% p = 0.02) and cancer-specific survival (88.5% vs 97.9%, p = 0.006). On MVA, GS ≥9 was a significant indicator of distant metastatic failure and cancer-related death. Seven-year overall survival rates remained similar between the groups. Conclusions: In this high-risk cohort, patients with GS 9-10 had significantly worse prostate cancer-related outcomes than other high-risk patients, suggesting that this group may warrant more aggressive treatment modalities than their high-risk counterparts.