To determine whether patients with Gleason score 5 + 3 = 8 prostate cancer have outcomes more similar to other patients with Gleason score 8 disease or to patients with Gleason score 9 disease.
The Surveillance, Epidemiology and End Results (SEER) database was used to study 40 533 men diagnosed with N0M0 Gleason score 8 or 9 prostate cancer from 2004 to 2011.
Using Gleason score 4 + 4 = 8 as the referent, Fine and Gray competing risks regression analyses modelled the association between Gleason score and prostate cancer-specific mortality (PCSM)
The 5-year PCSM rates for patients with Gleason score 4 + 4 = 8, 3 + 5 = 8, 5 + 3 = 8, and 9 disease were 6 3%, 6 6%, 13 5%, and 13 9%, respectively (P < 0 001) Patients with Gleason score 5 + 3 = 8 or 9 disease had up to a two-fold increased risk of PCSM (adjusted hazard ratio [AHR] 1 89, 95% confidence interval [CI] 1 50-2 38, P < 0 001; and AHR 2 17, 95% CI 1 99-2 36, P < 0 001, respectively) compared with the referent group of patients (Gleason score 4 + 4 = 8) There was no difference in PCSM between patients with Gleason score 5 + 3 = 8 vs 9 disease (P = 0 25)
Gleason score 8 disease represents a heterogeneous entity with PCSM outcomes distinguishable by the primary Gleason pattern The PCSM of Gleason score 3 + 5 = 8 and Gleason 4 + 4 = 8 disease are similar, but patients with Gleason score 5 + 3 = 8 have a risk of PCSM that is twice as high as other patients with Gleason score 8 disease and should be considered to have a similar poor prognosis as patients with Gleason score 9 disease Such patients should be allowed onto trials seeking the highest-risk patients in which to test novel aggressive treatment strategies
BJU international 2015 Jul 24 [Epub ahead of print]
Brandon A Mahal, Vinayak Muralidhar, Yu-Wei Chen, Toni K Choueiri, Karen E Hoffman, Jim C Hu, Christopher J Sweeney, James B Yu, Felix Y Feng, Quoc-Dien Trinh, Paul L Nguyen
Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA , Harvard Medical School, Boston, MA, USA , Harvard School of Public Health, Boston, MA, USA , Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA , Department of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Boston, MA, USA , Department of Urology, UCLA Medical Center, Los Angeles, CA, USA , Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA , Department of Therapeutic Radiology/Radiation Oncology, Yale, New Haven, CT, USA , Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA , Division of Urology, Brigham and Women's Hospital, Boston, MA, USA , Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA