Gleason stratifications prognostic for survival in men receiving definitive external beam radiation therapy for localized prostate cancer

Abstract Purpose Histologic grade analyses for prostate cancer (PCa) have traditionally included Gleason scores (GS) of ≤6, 7, and 8-10. Stratified biochemical progression-free survival has increasingly been reported within these groups on analyses of primary-secondary patterns (PSPs) (e.g., 3+4 vs....

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Published in:Urologic oncology 2015-02, Vol.33 (2), p.71.e11-71.e19
Main Authors: Rusthoven, Chad G., M.D, Waxweiler, Timothy V., M.D, DeWitt, Peter E., M.S, Flaig, Thomas W., M.D, Raben, David, M.D, Kavanagh, Brian D., M.D
Format: Article
Language:English
Subjects:
Aged
External beam radiation therapy
Gleason score
Humans
Male
Neoplasm Grading
Prognosis
Prostate cancer
Prostatic Neoplasms - mortality
Prostatic Neoplasms - pathology
Prostatic Neoplasms - radiotherapy
SEER Program
Survival
Survival Rate
Treatment Outcome
United States - epidemiology
Urology
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Summary:Abstract Purpose Histologic grade analyses for prostate cancer (PCa) have traditionally included Gleason scores (GS) of ≤6, 7, and 8-10. Stratified biochemical progression-free survival has increasingly been reported within these groups on analyses of primary-secondary patterns (PSPs) (e.g., 3+4 vs. 4+3) and overall GS (e.g., 8 vs. 9 vs. 10) but with limited data regarding stratified survival outcomes. In this analysis, outcomes for biopsy-assigned GS 6 to 10 were comprehensively evaluated to identify stratifications prognostic for survival in patients undergoing external beam radiation therapy (EBRT). Methods The Surveillance, Epidemiology, and End Results database was examined for T1–4 N0 M0, GS 6 to 10 PCa managed with EBRT alone from 2004 to 2006. GS and PSP variations were analyzed for PCa-specific survival (PCSS) and overall survival (OS). Results Overall, 26,885 patients were evaluated. Preliminary PSP analyses identified stratifications for 3+4 vs. 4+3 = 7 and 4+4 = 8 vs. GS 8 with pattern 5 (P5) (i.e., 3+5 and 5+3) as significant; however, no differences were observed for 4+5 vs. 5+4 = 9. The primary analysis included stratifications for GS 6, 3+4, 4+3, 4+4, 8 w/P5, 9, and 10, where the 7.5-year PCSS rates were 99%, 97%, 95%, 91%, 86%, 81%, and 78% and 7.5-year OS rates were 83%, 76%, 72%, 67%, 66%, 58%, and 54%, respectively. PCSS differences for sequential score increases were all significant on univariate analyses (all P
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2014.07.010