PURPOSE: To analyze the effect of primary Gleason (pG) grade among a large cohort of Gleason 7 prostate cancer patients treated with external beam radiation therapy (EBRT). METHODS AND MATERIALS: From May 1989 to January 2011, 1190 Gleason 7 patients with localized prostate cancer were treated with EBRT at a single institution. Of these patients, 613 had a Gleason 7 with a minimum of a sextant biopsy with nonfragmented cores and full biopsy core details available, including number of cores of cancer involved, percentage individual core involvement, location of disease, bilaterality, and presence of perineural invasion. Median follow-up was 6 years (range, 1-16 years). The prognostic implication for the following outcomes was analyzed: biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific mortality (PCSM). RESULTS: The 8-year bRFS rate for pG3 versus pG4 was 77.6% versus 61.3% (P<.0001), DMFS was 96.8% versus 84.3% (P<.0001), and PCSM was 3.7% versus 8.1% (P=.002). On multivariate analysis, pG4 predicted for significantly worse outcome in all parameters. Location of disease (apex, base, mid-gland), perineural involvement, maximum individual core involvement, and the number of Gleason 3+3, 3+4, or 4+3 cores did not predict for distant metastases. CONCLUSIONS: Primary Gleason grade 4 independently predicts for worse bRFS, DMFS, and PCSM among Gleason 7 patients. Using complete core information can allow clinicians to utilize pG grade as a prognostic factor, despite not having the full pathologic details from a prostatectomy specimen. Future staging and risk grouping should investigate the incorporation of primary Gleason grade when complete biopsy core information is used.
PURPOSE: To analyze the effect of primary Gleason (pG) grade among a large cohort of Gleason 7 prostate cancerpatients treated with external beam radiation therapy (EBRT). METHODS AND MATERIALS: From May 1989 to January 2011, 1190 Gleason 7 patients with localized prostate cancer were treated with EBRT at a single institution. Of these patients, 613 had a Gleason 7 with a minimum of a sextant biopsy with nonfragmented cores and full biopsy core details available, including number of cores of cancer involved, percentage individual core involvement, location of disease, bilaterality, and presence of perineural invasion. Median follow-up was 6 years (range, 1-16 years). The prognostic implication for the following outcomes was analyzed: biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific mortality (PCSM). RESULTS: The 8-year bRFS rate for pG3 versus pG4 was 77.6% versus 61.3% (P<.0001), DMFS was 96.8% versus 84.3% (P<.0001), and PCSM was 3.7% versus 8.1% (P=.002). On multivariate analysis, pG4 predicted for significantly worse outcome in all parameters. Location of disease (apex, base, mid-gland), perineural involvement, maximum individual core involvement, and the number of Gleason 3+3, 3+4, or 4+3 cores did not predict for distant metastases. CONCLUSIONS: Primary Gleason grade 4 independently predicts for worse bRFS, DMFS, and PCSM among Gleason 7 patients. Using complete core information can allow clinicians to utilize pG grade as a prognostic factor, despite not having the full pathologic details from a prostatectomy specimen. Future staging and risk grouping should investigate the incorporation of primary Gleason grade when complete biopsy core information is used.
Authors: Chiara Marigliano; Olivio F Donati; Hebert Alberto Vargas; Oguz Akin; Debra A Goldman; James A Eastham; Michael J Zelefsky; Hedvig Hricak Journal: Eur J Radiol Date: 2013-09-22 Impact factor: 3.528
Authors: Christopher Sweeney; Mari Nakabayashi; Meredith Regan; Wanling Xie; Julia Hayes; Nancy Keating; Suhui Li; Tomas Philipson; Marc Buyse; Susan Halabi; Philip Kantoff; A Oliver Sartor; Howard Soule; Brandon Mahal Journal: J Natl Cancer Inst Date: 2015-09-25 Impact factor: 13.506
Authors: Daniel E Spratt; Zachary S Zumsteg; Xin Pei; Paul B Romesser; Josh Yamada; Marisa A Kollmeier; Kaitlin Woo; Zhigang Zhang; Michael J Zelefsky Journal: Prostate Date: 2014-10-18 Impact factor: 4.104
Authors: D E Spratt; W C Jackson; A Abugharib; S A Tomlins; R T Dess; P D Soni; J Y Lee; S G Zhao; A I Cole; Z S Zumsteg; H Sandler; D Hamstra; J W Hearn; G Palapattu; R Mehra; T M Morgan; F Y Feng Journal: Prostate Cancer Prostatic Dis Date: 2016-05-24 Impact factor: 5.554