Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer–specific death in patients receiving salvage radiation therapy following radical prostatectomy
William C. Jackson,Daniel A. Hamstra,Skyler B. Johnson,Jessica Zhou,Benjamin Foster,Corey Foster,Darren Li,Yeohan Song,Ganesh S. Palapattu,Lakshmi P. Kunju,Rohit Mehra,Felix Y. Feng +11 more
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TLDR
The presence of Gleason pattern 5 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.Abstract:
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. Cancer 2013;119:3287–94. © 2013 American Cancer Society.read more
Citations
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Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review
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Adjuvant and salvage radiotherapy after radical prostatectomy in prostate cancer patients
Giorgio Gandaglia,Alberto Briganti,Noel W. Clarke,R. Jeffrey Karnes,Markus Graefen,Piet Ost,Anthony L. Zietman,Mack Roach +7 more
TL;DR: Postoperative radiotherapy has an impact on oncologic outcomes in patients with aggressive disease characteristics and Salvage radiotherapy administered at the first sign of recurrence might be associated with durable cancer control in selected patients but might compromise cure in others.
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American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer.
Daniel E. Spratt,Payal D. Soni,Patrick W. McLaughlin,Gregory S. Merrick,Richard G. Stock,John C. Blasko,Michael J. Zelefsky +6 more
TL;DR: Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high- risk population, and combination therapy may become the standard of care for high-risk cancers.
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The prognostic significance of Gleason scores in metastatic prostate cancer
Chad G. Rusthoven,Julie A. Carlson,Timothy V. Waxweiler,Norman Yeh,David Raben,Thomas W. Flaig,Brian D. Kavanagh +6 more
TL;DR: Overall, lower prostate-specific antigen level, younger age, and lower GS were associated with improved survival, with GS being the strongest prognostic factor for PCSS.
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Independent validation of the prognostic capacity of the ISUP prostate cancer grade grouping system for radiation treated patients with long-term follow-up.
Daniel E. Spratt,William C. Jackson,Ahmed E. Abugharib,Scott A. Tomlins,Robert T. Dess,Payal D. Soni,Jae Y. Lee,Shuang G. Zhao,Adam I. Cole,Zachary S. Zumsteg,H.M. Sandler,Daniel A. Hamstra,Jason W.D. Hearn,Ganesh S. Palapattu,Rohit Mehra,Todd M. Morgan,Felix Y. Feng +16 more
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