Mai Anh Huynh1, Ming-Hui Chen2, Jing Wu2, Michelle H Braccioforte3, Brian J Moran3, Anthony V D'Amico4. 1. Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: mahuynh@lroc.harvard.edu. 2. Department of Statistics, University of Connecticut, Storrs, CT, USA. 3. Chicago Prostate Cancer Center, Westmont, IL, USA. 4. Department of Radiation Oncology, Brigham and Women's Hospital-Dana Farber Cancer Institute, Boston, MA, USA.
Abstract
UNLABELLED: The International Society of Urological Pathology recommends that Gleason score (GS) 8 prostate cancer (PC) is one prognostic category, yet heterogeneity in cancer control potentially exists amongst men with GS 3+5/5+3 versus GS 4+4 PC. We compared PC-specific mortality (PCSM) and all-cause mortality (ACM) risk among men with GS 3+5/5+3 versus GS 4+4 PC using competing-risks and Cox regression analyses, adjusting for age, known PC prognostic factors, treatment, and a treatment propensity score. Between 1998 and 2012, 462 men with GS 8 PC were treated using brachytherapy with supplemental external-beam radiation therapy and/or androgen deprivation therapy at the Chicago Prostate Cancer Center. After a median follow-up of 7.6 yr, 118 men died, 26 of PC. PCSM (adjusted hazard ratio [AHR] 2.77, 95% confidence interval [CI] 1.13-6.80; p=0.026) and ACM (AHR 1.75, 95% CI 1.06-2.87; p=0.028) were significantly higher for men with GS 3+5/5+3 PC than for men with GS 4+4 PC. Subcategorizing GS 8 into PC with or without grade 5 should be considered as a stratification factor in randomized trials. PATIENT SUMMARY: Long-term success rates for men with Gleason score 8 prostate cancer vary depending on whether the most aggressive type of cancer (grade 5) is present at biopsy.
UNLABELLED: The International Society of Urological Pathology recommends that Gleason score (GS) 8 prostate cancer (PC) is one prognostic category, yet heterogeneity in cancer control potentially exists amongst men with GS 3+5/5+3 versus GS 4+4 PC. We compared PC-specific mortality (PCSM) and all-cause mortality (ACM) risk among men with GS 3+5/5+3 versus GS 4+4 PC using competing-risks and Cox regression analyses, adjusting for age, known PC prognostic factors, treatment, and a treatment propensity score. Between 1998 and 2012, 462 men with GS 8 PC were treated using brachytherapy with supplemental external-beam radiation therapy and/or androgen deprivation therapy at the Chicago Prostate Cancer Center. After a median follow-up of 7.6 yr, 118 men died, 26 of PC. PCSM (adjusted hazard ratio [AHR] 2.77, 95% confidence interval [CI] 1.13-6.80; p=0.026) and ACM (AHR 1.75, 95% CI 1.06-2.87; p=0.028) were significantly higher for men with GS 3+5/5+3 PC than for men with GS 4+4 PC. Subcategorizing GS 8 into PC with or without grade 5 should be considered as a stratification factor in randomized trials. PATIENT SUMMARY: Long-term success rates for men with Gleason score 8 prostate cancer vary depending on whether the most aggressive type of cancer (grade 5) is present at biopsy.
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