EAU 2018: Gleason 6 Prostate Cancer Is Not Always Harmless
For this study, the authors used the EMPaCT database, which contains data of over 9,500 patients who underwent radical prostatectomy + pelvic lymph node dissection (PLND) for high-risk prostate cancer (PSA >20 ng/ml or ≥cT3 or biopsy Gleason score 8-10) and included all patients who had biopsy Gleason 6 or pathological Gleason 6 prostate cancer. All patients had at least one of the following high-risk factors: PSA >20ng/ml or clinical stage cT3-T4. Patients were excluded if they had missing data on PSA, clinical stage, biopsy or pathological Gleason score, follow-up time or mortality data. Cancer-specific survival (CSS) was assessed using Kaplan-Meier analysis with log rank tests. Separate analyses were done for the biopsy Gleason 6 and pathological Gleason 6 prostate cancer subgroups.
Dr. Joniau identified 1,037 patients with biopsy Gleason 6 and 444 with pathologic Gleason 6 prostate cancer. In patients with biopsy Gleason 6 prostate cancer, estimated 14-year CSS was 90.8%, demonstrating that a subpopulation with biopsy Gleason 6 prostate cancer are at elevated risk of dying from their disease when having additional clinical high-risk prostate cancer features. The reason for this may be partly explained by a 64% upgrading to pathological Gleason score 7-10. However, in patients with pathologic Gleason 6 prostate cancer the estimated 14-year CSS was 96.6%, again demonstrating that not all patients with pathological Gleason 6 prostate cancer have a benign disease course.
The authors concluded that the results of the current study challenge the hypothesis that all patients with Gleason 6 prostate cancer have a benign disease course. Furthermore, they suggest that patients with biopsy or pathologic Gleason 6 prostate cancer and who have PSA >20ng/ml or clinical stage cT3-T4 are a subgroup at elevated risk of dying from their disease and should be counseled for active local treatment.
Presented by: Steven Joniau, University Hospitals Leuven, Leuven, Belgium
Co-Authors: Joniau S.1 , Spyrantis M.1 , Briganti A.2 , Chlosta P.3 , Gontero P.4 , Graefen M.5 ,Gratzke C.6 , Karnes J.7 , Marchioro G.8 , Sanchez-Salas R.9 , Spahn M.10 , Tombal B.11 , Van Der Poel H.12 , Van Poppel H.1
Author Information:
1. University Hospitals Leuven, Dept. of Urology, Leuven, Belgium,
2. Vita Salute San Raffaele University, Dept. of Urology, Milan, Italy,
3. Jagiellonian University, Dept. of Urology, Krakow, Poland,
4. University of Studies of Torino, Dept. of Urology, Turin, Italy,
5. Martini Clinic, Dept. of Urology, Hamburg, Germany,
6. Ludwig-Maximilians-Universit.tMünchen, Dept. of Urology, Munich, Germany,
7. Mayo Clinic, Dept. of Urology, Rochester, United States of America,
8. Azienda Ospedaliero Universitaria Maggiore della Carit., Dept. of Urology, Novara, Italy,
9. Unstitute Mutualiste Montsouris, Dept. of Urology, Paris, France,
10. Inselspital, Universit.tsspital Bern, Dept. of Urology, Bern, Switzerland,
11. Universit. Catholique de Louvain, Dept. of Urology, Brussels, Belgium,
12. Netherlands Cancer Institute, Dept. of Urology, Amsterdam, Netherlands,
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark