Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer

Sean P. Stroup, Daniel M. Moreira, Zinan Chen, Lauren Howard, Jonathan H. Berger, Martha K. Terris, William J. Aronson, Matthew R. Cooperberg, Christopher L. Amling, Christopher J. Kane, Stephen J. Freedland

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3 Scopus citations

Abstract

Purpose We evaluated the relative risk of biochemical recurrence, metastasis and death from prostate cancer contributed by biopsy Gleason pattern 5 among men at high risk with Gleason 8-10 disease in the SEARCH (Shared Equal Access Regional Cancer Hospital) cohort. Materials and Methods Men with biopsy Gleason sum 8-10 prostate cancer treated with radical prostatectomy were evaluated. The cohort was divided into men with Gleason 4 + 4 vs those with any pattern 5 (ie Gleason 3 + 5, 5 + 3, 4 + 5, 5 + 4 or 5 + 5). Predictors of biochemical recurrence, metastases, and prostate cancer specific and overall survival were analyzed using Kaplan-Meier, log rank test and Cox proportional hazards models. Results We identified 634 men at high risk in the SEARCH database, of whom 394 (62%) had Gleason 4 + 4 and 240 (38%) had Gleason pattern 5 on biopsy. Baseline characteristics did not significantly differ between the groups. On multivariable analysis relative to Gleason 4 + 4 men at high risk with Gleason pattern 5 showed no difference in the risk of biochemical recurrence (HR 1.26, 95% CI 0.99–1.61, p = 0.065). However, they were at significantly greater risk for metastasis (HR 2.55, 95% CI 1.50–4.35, p = 0.001), prostate cancer specific mortality (HR 2.67, 95% CI 0.1.26–5.66, p = 0.010) and overall mortality (HR 1.60, 95% CI 1.09–2.34, p = 0.016). Conclusions Preoperative subclassification of high risk prostate cancer by biopsy Gleason grade (4 + 4 vs any Gleason pattern 5) identified men at highest risk for progression. Any Gleason 5 on biopsy is associated with a greater risk of metastasis, and prostate cancer specific and overall mortality. Grouping all Gleason 8-10 tumors together as high risk lesions may fail to fully stratify men at highest risk for poor outcomes.

Original languageEnglish (US)
Pages (from-to)1309-1315
Number of pages7
JournalJournal of Urology
Volume198
Issue number6
DOIs
StatePublished - Dec 2017

Keywords

  • local
  • mortality
  • neoplasm grading
  • neoplasm recurrence
  • prostatectomy
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

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    Stroup, S. P., Moreira, D. M., Chen, Z., Howard, L., Berger, J. H., Terris, M. K., Aronson, W. J., Cooperberg, M. R., Amling, C. L., Kane, C. J., & Freedland, S. J. (2017). Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer. Journal of Urology, 198(6), 1309-1315. https://doi.org/10.1016/j.juro.2017.07.009