Kiri A Sandler1, Ryan R Cook2, Jay P Ciezki3, Ashley E Ross4, Mark M Pomerantz5, Paul L Nguyen6, Talha Shaikh7, Phuoc T Tran8, Richard G Stock9, Gregory S Merrick10, D Jeffrey Demanes1, Daniel E Spratt11, Eyad I Abu-Isa11, Trude B Wedde12, Wolfgang Lilleby12, Daniel J Krauss13, Grace K Shaw5, Ridwan Alam4, Chandana A Reddy3, Daniel Y Song9, Eric A Klein3, Andrew J Stephenson3, Jeffrey J Tosoian4, John V Hegde1, Sun Mi Yoo1, Ryan Fiano9, Anthony V D'Amico5, Nicholas G Nickols14, William J Aronson15, Ahmad Sadeghi16, Stephen C Greco8, Curtiland Deville8, Todd McNutt8, Theodore L DeWeese8, Robert E Reiter17, Jonathan W Said18, Michael L Steinberg1, Eric M Horwitz7, Patrick A Kupelian1, Christopher R King1, Amar U Kishan19. 1. Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California. 2. Department of Epidemiology, Fielding School of Public Health at UCLA, Los Angeles, California. 3. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. 4. Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. 6. Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. 7. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. 8. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. 9. Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York. 10. Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, West Virginia. 11. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 12. Department of Oncology, Oslo University Hospital-Norwegian Radium Hospital, Norway. 13. William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan. 14. Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California; Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California. 15. Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Urology, University of California, Los Angeles, Los Angeles, California. 16. Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California. 17. Department of Urology, University of California, Los Angeles, Los Angeles, California. 18. Department of Pathology, University of California, Los Angeles, Los Angeles, California. 19. Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California. Electronic address: aukishan@mednet.ucla.edu.
Abstract
PURPOSE: Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis of patients presenting with GS 10 PCa are largely unknown because of its rarity. METHODS AND MATERIALS: The study included 112 patients with biopsy-determined GS 10 PCa who received treatment with radical prostatectomy (RP, n = 26), external beam radiation therapy (EBRT, n = 48), or EBRT with a brachytherapy boost (EBRT-BT, n = 38) between 2000 and 2013. Propensity scores were included as covariates for comparative analysis. Overall survival, prostate cancer-specific survival, and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method with inverse probability of treatment weighting to control for confounding. RESULTS: The median follow-up period was 4.9 years overall (3.9 years for RP, 4.8 years for EBRT, and 5.7 years for EBRT-BT). Significantly more EBRT patients than EBRT-BT patients received upfront androgen deprivation therapy (98% vs 79%, P < .01 by χ2 test), though the durations were similar (median, 24 months vs 22.5 months). Of the RP patients, 34% received postoperative EBRT, and 35% received neoadjuvant systemic therapy. The propensity score-adjusted 5-year overall survival rate was 80% for the RP group, 73% for the EBRT group, and 83% for the EBRT-BT group. The corresponding adjusted 5-year prostate cancer-specific survival rates were 87%, 75%, and 94%, respectively. The EBRT-BT group trended toward superior DMFS when compared with the RP group (hazard ratio, 0.3; 95% confidence interval 0.1-1.06; P = .06) and had superior DMFS when compared with the EBRT group (hazard ratio, 0.4; 95% confidence interval 0.1-0.99; P = .048). CONCLUSIONS: To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy-determined GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease 5 years after treatment.
PURPOSE: Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis of patients presenting with GS 10 PCa are largely unknown because of its rarity. METHODS AND MATERIALS: The study included 112 patients with biopsy-determined GS 10 PCa who received treatment with radical prostatectomy (RP, n = 26), external beam radiation therapy (EBRT, n = 48), or EBRT with a brachytherapy boost (EBRT-BT, n = 38) between 2000 and 2013. Propensity scores were included as covariates for comparative analysis. Overall survival, prostate cancer-specific survival, and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method with inverse probability of treatment weighting to control for confounding. RESULTS: The median follow-up period was 4.9 years overall (3.9 years for RP, 4.8 years for EBRT, and 5.7 years for EBRT-BT). Significantly more EBRTpatients than EBRT-BT patients received upfront androgen deprivation therapy (98% vs 79%, P < .01 by χ2 test), though the durations were similar (median, 24 months vs 22.5 months). Of the RP patients, 34% received postoperative EBRT, and 35% received neoadjuvant systemic therapy. The propensity score-adjusted 5-year overall survival rate was 80% for the RP group, 73% for the EBRT group, and 83% for the EBRT-BT group. The corresponding adjusted 5-year prostate cancer-specific survival rates were 87%, 75%, and 94%, respectively. The EBRT-BT group trended toward superior DMFS when compared with the RP group (hazard ratio, 0.3; 95% confidence interval 0.1-1.06; P = .06) and had superior DMFS when compared with the EBRT group (hazard ratio, 0.4; 95% confidence interval 0.1-0.99; P = .048). CONCLUSIONS: To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy-determined GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease 5 years after treatment.