Clinical outcomes for patients with Gleason Score 10 prostate adenocarcinoma: results from a multi-institutional consortium study

Publication date: Available online 5 April 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Kiri A. Sandler, Ryan R. Cook, Jay P. Ciezki, Ashley E. Ross, Mark M. Pomerantz, Paul L. Nguyen, Talha Shaikh, Phuoc T. Tran, Richard G. Stock, Gregory S. Merrick, D. Jeffrey Demanes, Daniel E. Spratt, Eyad I. Abu-Isa, Trude B. Wedde, Wolfgang Lilleby, Daniel J. Krauss, Grace K. Shaw, Ridwan Alam, Chandana A. Reddy, Daniel Y. Song, Eric A. Klein, Andrew J. Stephenson, Jeffrey J. Tosoian, John V. Hegde, Sun Mi Yoo, Ryan Fiano, Anthony V. D'Amico, Nicholas G. Nickols, William J. Aronson, Ahmad Sadeghi, Stephen C. Greco, Curtiland Deville, Todd McNutt, Theodore L. DeWeese, Robert E. Reiter, Jonathan W. Said, Michael L. Steinberg, Eric M. Horwitz, Patrick A. Kupelian, Christopher R. King, Amar U. Kishan
BackgroundGleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis for patients presenting with GS 10 PCa are largely unknown due to its rarity.Methods112 patients with biopsy GS 10 PCa who received treatment with radical prostatectomy (RP, n=26), external beam radiotherapy (EBRT, n=48), and EBRT with a brachytherapy boost (EBRT+BT, n=38) between 2000-2013 were included. Propensity scores were included as covariates for comparative analysis. Overall survival (OS), prostate cancer-specific survival (PCSS), and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method with inverse probability of treatment weighting to control for confounding.ResultsThe median follow-up was 4.9 years overall (3.9 for RP, 4.8 for EBRT, and 5.7 for EBRT+BT). Significantly more EBRT than EBRT+BT patients received upfront ADT (98% vs 79%, p<0.01 by Chi square), though durations were similar (median 24 and 22.5 months, respectively). Thirty-four percent of RP patients received postoperative EBRT, and 35% received neoadjuvant systemic therapy. Propensity score-adjusted 5-year OS was 80% for the RP group, 73% for the EBRT group, and 83% for EBRT+BT group. Corresponding adjusted 5-year PCSS rates were 87%, 75%, and 94%, respectively. EBRT+BT trended toward superior DMFS when compared with RP (HR 0.3, 95% CI 0.1-1.06, p = .06) and had superior DMFS when compared with EBRT (HR 0.4, 95% CI 0.1-0.99, p = .048).ConclusionsTo our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy 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 five years following treatment.

Teaser

Gleason 10 prostate cancer is extremely aggressive, and clinical outcomes are largely unknown due to its rarity. This study provides benchmark clinical outcomes information for patients with Gleason 10 prostate cancer with data extracted from a large multi-institutional database. Though it follows an aggressive course, the majority of patients are free from disease at 5 years, and there may be benefits to treating with radiation and brachytherapy.


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