Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results From a Multi-institutional Consortium Study

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. SongEric 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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)883-888
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume101
Issue number4
DOIs
StatePublished - Jul 15 2018

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Sandler, K. A., Cook, R. R., Ciezki, J. P., Ross, A. E., Pomerantz, M. M., Nguyen, P. L., Shaikh, T., Tran, P. T., Stock, R. G., Merrick, G. S., Demanes, D. J., Spratt, D. E., Abu-Isa, E. I., Wedde, T. B., Lilleby, W., Krauss, D. J., Shaw, G. K., Alam, R., Reddy, C. A., ... Kishan, A. U. (2018). Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results From a Multi-institutional Consortium Study. International Journal of Radiation Oncology Biology Physics, 101(4), 883-888. https://doi.org/10.1016/j.ijrobp.2018.03.060