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 Kennedy Terris, William J. Aronson, Matthew R. Cooperberg, Christopher L. Amling, Christopher J. Kane, Stephen J. Freedland

Research output: Contribution to journalArticle

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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 1 2017

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Prostatic Neoplasms
Neoplasm Metastasis
Biopsy
Recurrence
Mortality
Cancer Care Facilities
Prostatectomy
Proportional Hazards Models
Databases
Survival

Keywords

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

ASJC Scopus subject areas

  • Urology

Cite this

Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer. / Stroup, Sean P.; Moreira, Daniel M.; Chen, Zinan; Howard, Lauren; Berger, Jonathan H.; Terris, Martha Kennedy; Aronson, William J.; Cooperberg, Matthew R.; Amling, Christopher L.; Kane, Christopher J.; Freedland, Stephen J.

In: Journal of Urology, Vol. 198, No. 6, 01.12.2017, p. 1309-1315.

Research output: Contribution to journalArticle

Stroup, SP, Moreira, DM, Chen, Z, Howard, L, Berger, JH, Terris, MK, Aronson, WJ, Cooperberg, MR, Amling, CL, Kane, CJ & Freedland, SJ 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, vol. 198, no. 6, pp. 1309-1315. https://doi.org/10.1016/j.juro.2017.07.009
Stroup, Sean P. ; Moreira, Daniel M. ; Chen, Zinan ; Howard, Lauren ; Berger, Jonathan H. ; Terris, Martha Kennedy ; Aronson, William J. ; Cooperberg, Matthew R. ; Amling, Christopher L. ; Kane, Christopher J. ; Freedland, Stephen J. / Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer. In: Journal of Urology. 2017 ; Vol. 198, No. 6. pp. 1309-1315.
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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.",
keywords = "local, mortality, neoplasm grading, neoplasm recurrence, prostatectomy, prostatic neoplasms",
author = "Stroup, {Sean P.} and Moreira, {Daniel M.} and Zinan Chen and Lauren Howard and Berger, {Jonathan H.} and Terris, {Martha Kennedy} and Aronson, {William J.} and Cooperberg, {Matthew R.} and Amling, {Christopher L.} and Kane, {Christopher J.} and Freedland, {Stephen J.}",
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T1 - Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer

AU - Stroup, Sean P.

AU - Moreira, Daniel M.

AU - Chen, Zinan

AU - Howard, Lauren

AU - Berger, Jonathan H.

AU - Terris, Martha Kennedy

AU - Aronson, William J.

AU - Cooperberg, Matthew R.

AU - Amling, Christopher L.

AU - Kane, Christopher J.

AU - Freedland, Stephen J.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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.

AB - 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.

KW - local

KW - mortality

KW - neoplasm grading

KW - neoplasm recurrence

KW - prostatectomy

KW - prostatic neoplasms

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