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J Urol. 2017 Dec;198(6):1309-1315. doi: 10.1016/j.juro.2017.07.009. Epub 2017 Jul 11.

Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer.

Author information

1
Department of Urology, Naval Medical Center San Diego, San Diego, California; Department of Urology, University of California-San Diego, San Diego, California. Electronic address: sean.p.stroup.mil@mail.mil.
2
Department of Urology, Mayo Clinic, Rochester, Minnesota.
3
Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina.
4
Department of Urology, Naval Medical Center San Diego, San Diego, California.
5
Augusta Veterans Affairs Medical Center, Augusta, Georgia.
6
West Los Angeles Veterans Affairs Medical Center, West Los Angeles, California; University of California-Los Angeles School of Medicine, Los Angeles, California.
7
San Francisco Veterans Affairs Medical Center and University of California, San Francisco, San Francisco, California.
8
Oregon Health and Sciences University, Portland, Oregon.
9
Department of Urology, University of California-San Diego, San Diego, California; San Diego Veterans Affairs Medical Center, San Diego, California.
10
Cedars Sinai Medical Center, Los Angeles, California.

Abstract

PURPOSE:

We evaluated the relative risk of biochemical recurrence, metastasis and death from prostate cancer contributed by biopsy Gleason pattern 5 among men at high risk with Gleason 8-10 disease in the SEARCH (Shared Equal Access Regional Cancer Hospital) cohort.

MATERIALS AND METHODS:

Men with biopsy Gleason sum 8-10 prostate cancer treated with radical prostatectomy were evaluated. The cohort was divided into men with Gleason 4 + 4 vs those with any pattern 5 (ie Gleason 3 + 5, 5 + 3, 4 + 5, 5 + 4 or 5 + 5). Predictors of biochemical recurrence, metastases, and prostate cancer specific and overall survival were analyzed using Kaplan-Meier, log rank test and Cox proportional hazards models.

RESULTS:

We identified 634 men at high risk in the SEARCH database, of whom 394 (62%) had Gleason 4 + 4 and 240 (38%) had Gleason pattern 5 on biopsy. Baseline characteristics did not significantly differ between the groups. On multivariable analysis relative to Gleason 4 + 4 men at high risk with Gleason pattern 5 showed no difference in the risk of biochemical recurrence (HR 1.26, 95% CI 0.99-1.61, p = 0.065). However, they were at significantly greater risk for metastasis (HR 2.55, 95% CI 1.50-4.35, p = 0.001), prostate cancer specific mortality (HR 2.67, 95% CI 0.1.26-5.66, p = 0.010) and overall mortality (HR 1.60, 95% CI 1.09-2.34, p = 0.016).

CONCLUSIONS:

Preoperative subclassification of high risk prostate cancer by biopsy Gleason grade (4 + 4 vs any Gleason pattern 5) identified men at highest risk for progression. Any Gleason 5 on biopsy is associated with a greater risk of metastasis, and prostate cancer specific and overall mortality. Grouping all Gleason 8-10 tumors together as high risk lesions may fail to fully stratify men at highest risk for poor outcomes.

KEYWORDS:

local; mortality; neoplasm recurrence; neoplasm grading; prostatectomy; prostatic neoplasms

PMID:
28709888
DOI:
10.1016/j.juro.2017.07.009

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