BACKGROUND: The presence of Gleason pattern 5 (GP5) at radical prostatectomy (RP) has been associated with worse clinical outcome; however, this pathologic variable has not been assessed in patients receiving salvage radiation therapy (SRT) after a rising prostate-specific antigen level. METHODS: A total of 575 patients who underwent primary RP for localized prostate cancer and subsequently received SRT at a tertiary medical institution were reviewed retrospectively. Primary outcomes of interest were biochemical failure (BF), distant metastasis (DM), and prostate cancer-specific mortality (PCSM), which were assessed via univariate analysis and Fine and Grays competing risks multivariate models. RESULTS: On pathologic evaluation, 563 (98%) patients had a documented Gleason score (GS). The median follow-up post-SRT was 56.7 months. A total of 60 (10.7%) patients had primary, secondary, or tertiary GP5. On univariate analysis, the presence of GP5 was prognostic for BF (hazard ratio [HR] 3.3; P < .0001), DM (HR:11.1, P < .0001), and PCSM (HR:8.8, P < .0001). Restratification of the Gleason score to include GP5 as a distinct entity resulted in improved prognostic capability. Patients with GP5 had clinically worse outcomes than patients with GS8(4+4). On multivariate analysis, the presence of GP5 was the most adverse pathologic predictor of BF (HR 2.9; P < .0001), DM (HR 14.8; P < .0001), and PCSM (HR 5.7; P < .0001). CONCLUSION: In the setting of SRT for prostate cancer, the presence of GP5 is a critical pathologic predictor of BF, DM, and PCSM. Traditional GS risk stratification fails to fully utilize the prognostic capabilities of individual Gleason patterns among men receiving SRT post-RP.
BACKGROUND: The presence of Gleason pattern 5 (GP5) at radical prostatectomy (RP) has been associated with worse clinical outcome; however, this pathologic variable has not been assessed in patients receiving salvage radiation therapy (SRT) after a rising prostate-specific antigen level. METHODS: A total of 575 patients who underwent primary RP for localized prostate cancer and subsequently received SRT at a tertiary medical institution were reviewed retrospectively. Primary outcomes of interest were biochemical failure (BF), distant metastasis (DM), and prostate cancer-specific mortality (PCSM), which were assessed via univariate analysis and Fine and Grays competing risks multivariate models. RESULTS: On pathologic evaluation, 563 (98%) patients had a documented Gleason score (GS). The median follow-up post-SRT was 56.7 months. A total of 60 (10.7%) patients had primary, secondary, or tertiary GP5. On univariate analysis, the presence of GP5 was prognostic for BF (hazard ratio [HR] 3.3; P < .0001), DM (HR:11.1, P < .0001), and PCSM (HR:8.8, P < .0001). Restratification of the Gleason score to include GP5 as a distinct entity resulted in improved prognostic capability. Patients with GP5 had clinically worse outcomes than patients with GS8(4+4). On multivariate analysis, the presence of GP5 was the most adverse pathologic predictor of BF (HR 2.9; P < .0001), DM (HR 14.8; P < .0001), and PCSM (HR 5.7; P < .0001). CONCLUSION: In the setting of SRT for prostate cancer, the presence of GP5 is a critical pathologic predictor of BF, DM, and PCSM. Traditional GS risk stratification fails to fully utilize the prognostic capabilities of individual Gleason patterns among men receiving SRT post-RP.
Authors: Ariel A Schulman; Lauren E Howard; Kae Jack Tay; Efrat Tsivian; Christina Sze; Christopher L Amling; William J Aronson; Matthew R Cooperberg; Christopher J Kane; Martha K Terris; Stephen J Freedland; Thomas J Polascik Journal: Cancer Date: 2017-06-29 Impact factor: 6.860
Authors: Kiri A Sandler; Ryan R Cook; Jay P Ciezki; Ashley E Ross; Mark M Pomerantz; Paul L Nguyen; Talha Shaikh; Phuoc T Tran; Richard G Stock; Gregory S Merrick; David Jeffrey Demanes; Daniel E Spratt; Eyad I Abu-Isa; Trude B Wedde; Wolfgang Lilleby; Daniel J Krauss; Grace K Shaw; Ridwan Alam; Chandana A Reddy; Daniel Y Song; Eric A Klein; Andrew J Stephenson; Jeffrey J Tosoian; John V Hegde; Sun Mi Yoo; Ryan Fiano; Anthony V D'Amico; Nicholas G Nickols; William J Aronson; Ahmad Sadeghi; Stephen C Greco; Curtiland Deville; Todd McNutt; Theodore L DeWeese; Robert E Reiter; Jonathan W Said; Michael L Steinberg; Eric M Horwitz; Patrick A Kupelian; Christopher R King; Amar U Kishan Journal: Eur Urol Date: 2019-04-13 Impact factor: 20.096
Authors: Daniel A Hamstra; Stephanie L Pugh; Herbert Lepor; Seth A Rosenthal; Kenneth J Pienta; Leonard Gomella; Christopher Peters; David Paul D'Souza; Kenneth L Zeitzer; Christopher U Jones; William A Hall; Eric Horwitz; Thomas M Pisansky; Luis Souhami; Alan C Hartford; Michael Dominello; Felix Feng; Howard M Sandler Journal: Radiother Oncol Date: 2019-09-17 Impact factor: 6.280
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