TY - JOUR
T1 - Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma
T2 - Results From a Multi-institutional Consortium Study
AU - Sandler, Kiri A.
AU - Cook, Ryan R.
AU - Ciezki, Jay P.
AU - Ross, Ashley E.
AU - Pomerantz, Mark M.
AU - Nguyen, Paul L.
AU - Shaikh, Talha
AU - Tran, Phuoc T.
AU - Stock, Richard G.
AU - Merrick, Gregory S.
AU - Demanes, D. Jeffrey
AU - Spratt, Daniel E.
AU - Abu-Isa, Eyad I.
AU - Wedde, Trude B.
AU - Lilleby, Wolfgang
AU - Krauss, Daniel J.
AU - Shaw, Grace K.
AU - Alam, Ridwan
AU - Reddy, Chandana A.
AU - Song, Daniel Y.
AU - Klein, Eric A.
AU - Stephenson, Andrew J.
AU - Tosoian, Jeffrey J.
AU - Hegde, John V.
AU - Yoo, Sun Mi
AU - Fiano, Ryan
AU - D'Amico, Anthony V.
AU - Nickols, Nicholas G.
AU - Aronson, William J.
AU - Sadeghi, Ahmad
AU - Greco, Stephen C.
AU - Deville, Curtiland
AU - McNutt, Todd
AU - DeWeese, Theodore L.
AU - Reiter, Robert E.
AU - Said, Jonathan W.
AU - Steinberg, Michael L.
AU - Horwitz, Eric M.
AU - Kupelian, Patrick A.
AU - King, Christopher R.
AU - Kishan, Amar U.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/7/15
Y1 - 2018/7/15
N2 - 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 χ 2 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.
AB - 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 χ 2 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.
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U2 - 10.1016/j.ijrobp.2018.03.060
DO - 10.1016/j.ijrobp.2018.03.060
M3 - Article
C2 - 29976500
AN - SCOPUS:85048841793
SN - 0360-3016
VL - 101
SP - 883
EP - 888
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 4
ER -