Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative gleason sum of 8 to 10

Patrick J. Bastian, Mark L. Gonzalgo, William J. Aronson, Martha Kennedy Terris, Christopher J. Kane, Christopher L. Amling, Joseph C. Presti, Leslie A. Mangold, Elizabeth Humphreys, Jonathan I. Epstein, Alan W. Partin, Stephen J. Freedland

Research output: Contribution to journalReview article

84 Citations (Scopus)

Abstract

BACKGROUND. Men with a biopsy Gleason sum of 8 to 10 are considered high-risk. The current study sought to identify whether there was a subset of men with high biopsy Gleason sums who would have a good pathologic and biochemical out-come with surgical monotherapy. To increase the generalizability of the findings, data were used from patients treated at 2 very different practice settings: a tertiary care referral center (Johns Hopkins Hospital) and multiple equal-access medical centers (Shared Equal Access Regional Cancer Hospital [SEARCH] Database). METHODS. The data were retrospectively reviewed from men with biopsy Gleason sums 8 to 10 treated by radical prostatectomy at the Johns Hopkins Hospital (n = 220, 3.8% of total cohort) and within the SEARCH Database (n = 149, 7.7% of total cohort). The preoperative clinical characteristics predicting unfavorable pathologic disease (nonorgan-confined and/or positive surgical margins) and time to biochemical recurrence were determined using logistic regression and Cox proportional hazards analysis, respectively. RESULTS. Favorable pathologic outcome (organ-confined and negative surgical margins) was observed in 21% of the men in the Johns Hopkins cohort and 41% from the SEARCH cohort. On multivariate analysis, higher serum prostate-specific antigen (PSA) was the only variable that significantly predicted an unfavorable pathologic outcome from both the Johns Hopkins (P = .047) and SEARCH cohorts (P =.002). The 5-year and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 40% (95% confidence interval [CI], 33-48%) and 27% (95% CI, 18-36%), respectively, and 32% (95% CI, 22-42%) and 28% (95% CI, 18-38%) in the SEARCH cohort, respectively. Among men with favorable pathologic findings, the 5- and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 79% (95% CI, 62-89%) and 50% (95% CI, 25-71%), respectively, and 49% (95% CI, 32-65%) and 49% (95% CI, 32-65%) in the SEARCH cohort, respectively. No single preoperative variable significantly predicted the risk of biochemical progression in both the SEARCH or Johns Hopkins cohorts. CONCLUSIONS. The majority of men with a biopsy Gleason sum of ≥8, regardless of where the patient is treated, had unfavorable pathologic disease and experienced a biochemical progression after radical prostatectomy. Even among men with organ-confined disease and negative surgical margins or pathologic Gleason sum <8, at least half of the men experienced a PSA recurrence. Patients with biopsy Gleason sum 8 to 10 cancers are good candidates for multimodal therapy. Whereas multimodal therapy has often meant radiation plus hormonal therapy, newer possibilities for multimodal therapy exist such as surgery with neoadjuvant or adjuvant chemohormonal therapy or surgery with adjuvant radiation.

Original languageEnglish (US)
Pages (from-to)1265-1272
Number of pages8
JournalCancer
Volume107
Issue number6
DOIs
StatePublished - Sep 15 2006

Fingerprint

Cancer Care Facilities
Prostatectomy
Prostatic Neoplasms
Confidence Intervals
Biopsy
Prostate-Specific Antigen
Tertiary Care Centers
Survival Rate
Databases
Radiation
Therapeutics
Recurrence
Operative Time
Multivariate Analysis
Logistic Models
Serum

Keywords

  • Gleason score 8 to 10
  • High risk
  • Prostate cancer
  • Radical prostatectomy
  • Recurrence

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Bastian, P. J., Gonzalgo, M. L., Aronson, W. J., Terris, M. K., Kane, C. J., Amling, C. L., ... Freedland, S. J. (2006). Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative gleason sum of 8 to 10. Cancer, 107(6), 1265-1272. https://doi.org/10.1002/cncr.22116

Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative gleason sum of 8 to 10. / Bastian, Patrick J.; Gonzalgo, Mark L.; Aronson, William J.; Terris, Martha Kennedy; Kane, Christopher J.; Amling, Christopher L.; Presti, Joseph C.; Mangold, Leslie A.; Humphreys, Elizabeth; Epstein, Jonathan I.; Partin, Alan W.; Freedland, Stephen J.

In: Cancer, Vol. 107, No. 6, 15.09.2006, p. 1265-1272.

Research output: Contribution to journalReview article

Bastian, PJ, Gonzalgo, ML, Aronson, WJ, Terris, MK, Kane, CJ, Amling, CL, Presti, JC, Mangold, LA, Humphreys, E, Epstein, JI, Partin, AW & Freedland, SJ 2006, 'Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative gleason sum of 8 to 10', Cancer, vol. 107, no. 6, pp. 1265-1272. https://doi.org/10.1002/cncr.22116
Bastian, Patrick J. ; Gonzalgo, Mark L. ; Aronson, William J. ; Terris, Martha Kennedy ; Kane, Christopher J. ; Amling, Christopher L. ; Presti, Joseph C. ; Mangold, Leslie A. ; Humphreys, Elizabeth ; Epstein, Jonathan I. ; Partin, Alan W. ; Freedland, Stephen J. / Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative gleason sum of 8 to 10. In: Cancer. 2006 ; Vol. 107, No. 6. pp. 1265-1272.
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title = "Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative gleason sum of 8 to 10",
abstract = "BACKGROUND. Men with a biopsy Gleason sum of 8 to 10 are considered high-risk. The current study sought to identify whether there was a subset of men with high biopsy Gleason sums who would have a good pathologic and biochemical out-come with surgical monotherapy. To increase the generalizability of the findings, data were used from patients treated at 2 very different practice settings: a tertiary care referral center (Johns Hopkins Hospital) and multiple equal-access medical centers (Shared Equal Access Regional Cancer Hospital [SEARCH] Database). METHODS. The data were retrospectively reviewed from men with biopsy Gleason sums 8 to 10 treated by radical prostatectomy at the Johns Hopkins Hospital (n = 220, 3.8{\%} of total cohort) and within the SEARCH Database (n = 149, 7.7{\%} of total cohort). The preoperative clinical characteristics predicting unfavorable pathologic disease (nonorgan-confined and/or positive surgical margins) and time to biochemical recurrence were determined using logistic regression and Cox proportional hazards analysis, respectively. RESULTS. Favorable pathologic outcome (organ-confined and negative surgical margins) was observed in 21{\%} of the men in the Johns Hopkins cohort and 41{\%} from the SEARCH cohort. On multivariate analysis, higher serum prostate-specific antigen (PSA) was the only variable that significantly predicted an unfavorable pathologic outcome from both the Johns Hopkins (P = .047) and SEARCH cohorts (P =.002). The 5-year and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 40{\%} (95{\%} confidence interval [CI], 33-48{\%}) and 27{\%} (95{\%} CI, 18-36{\%}), respectively, and 32{\%} (95{\%} CI, 22-42{\%}) and 28{\%} (95{\%} CI, 18-38{\%}) in the SEARCH cohort, respectively. Among men with favorable pathologic findings, the 5- and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 79{\%} (95{\%} CI, 62-89{\%}) and 50{\%} (95{\%} CI, 25-71{\%}), respectively, and 49{\%} (95{\%} CI, 32-65{\%}) and 49{\%} (95{\%} CI, 32-65{\%}) in the SEARCH cohort, respectively. No single preoperative variable significantly predicted the risk of biochemical progression in both the SEARCH or Johns Hopkins cohorts. CONCLUSIONS. The majority of men with a biopsy Gleason sum of ≥8, regardless of where the patient is treated, had unfavorable pathologic disease and experienced a biochemical progression after radical prostatectomy. Even among men with organ-confined disease and negative surgical margins or pathologic Gleason sum <8, at least half of the men experienced a PSA recurrence. Patients with biopsy Gleason sum 8 to 10 cancers are good candidates for multimodal therapy. Whereas multimodal therapy has often meant radiation plus hormonal therapy, newer possibilities for multimodal therapy exist such as surgery with neoadjuvant or adjuvant chemohormonal therapy or surgery with adjuvant radiation.",
keywords = "Gleason score 8 to 10, High risk, Prostate cancer, Radical prostatectomy, Recurrence",
author = "Bastian, {Patrick J.} and Gonzalgo, {Mark L.} and Aronson, {William J.} and Terris, {Martha Kennedy} and Kane, {Christopher J.} and Amling, {Christopher L.} and Presti, {Joseph C.} and Mangold, {Leslie A.} and Elizabeth Humphreys and Epstein, {Jonathan I.} and Partin, {Alan W.} and Freedland, {Stephen J.}",
year = "2006",
month = "9",
day = "15",
doi = "10.1002/cncr.22116",
language = "English (US)",
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TY - JOUR

T1 - Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative gleason sum of 8 to 10

AU - Bastian, Patrick J.

AU - Gonzalgo, Mark L.

AU - Aronson, William J.

AU - Terris, Martha Kennedy

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Presti, Joseph C.

AU - Mangold, Leslie A.

AU - Humphreys, Elizabeth

AU - Epstein, Jonathan I.

AU - Partin, Alan W.

AU - Freedland, Stephen J.

PY - 2006/9/15

Y1 - 2006/9/15

N2 - BACKGROUND. Men with a biopsy Gleason sum of 8 to 10 are considered high-risk. The current study sought to identify whether there was a subset of men with high biopsy Gleason sums who would have a good pathologic and biochemical out-come with surgical monotherapy. To increase the generalizability of the findings, data were used from patients treated at 2 very different practice settings: a tertiary care referral center (Johns Hopkins Hospital) and multiple equal-access medical centers (Shared Equal Access Regional Cancer Hospital [SEARCH] Database). METHODS. The data were retrospectively reviewed from men with biopsy Gleason sums 8 to 10 treated by radical prostatectomy at the Johns Hopkins Hospital (n = 220, 3.8% of total cohort) and within the SEARCH Database (n = 149, 7.7% of total cohort). The preoperative clinical characteristics predicting unfavorable pathologic disease (nonorgan-confined and/or positive surgical margins) and time to biochemical recurrence were determined using logistic regression and Cox proportional hazards analysis, respectively. RESULTS. Favorable pathologic outcome (organ-confined and negative surgical margins) was observed in 21% of the men in the Johns Hopkins cohort and 41% from the SEARCH cohort. On multivariate analysis, higher serum prostate-specific antigen (PSA) was the only variable that significantly predicted an unfavorable pathologic outcome from both the Johns Hopkins (P = .047) and SEARCH cohorts (P =.002). The 5-year and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 40% (95% confidence interval [CI], 33-48%) and 27% (95% CI, 18-36%), respectively, and 32% (95% CI, 22-42%) and 28% (95% CI, 18-38%) in the SEARCH cohort, respectively. Among men with favorable pathologic findings, the 5- and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 79% (95% CI, 62-89%) and 50% (95% CI, 25-71%), respectively, and 49% (95% CI, 32-65%) and 49% (95% CI, 32-65%) in the SEARCH cohort, respectively. No single preoperative variable significantly predicted the risk of biochemical progression in both the SEARCH or Johns Hopkins cohorts. CONCLUSIONS. The majority of men with a biopsy Gleason sum of ≥8, regardless of where the patient is treated, had unfavorable pathologic disease and experienced a biochemical progression after radical prostatectomy. Even among men with organ-confined disease and negative surgical margins or pathologic Gleason sum <8, at least half of the men experienced a PSA recurrence. Patients with biopsy Gleason sum 8 to 10 cancers are good candidates for multimodal therapy. Whereas multimodal therapy has often meant radiation plus hormonal therapy, newer possibilities for multimodal therapy exist such as surgery with neoadjuvant or adjuvant chemohormonal therapy or surgery with adjuvant radiation.

AB - BACKGROUND. Men with a biopsy Gleason sum of 8 to 10 are considered high-risk. The current study sought to identify whether there was a subset of men with high biopsy Gleason sums who would have a good pathologic and biochemical out-come with surgical monotherapy. To increase the generalizability of the findings, data were used from patients treated at 2 very different practice settings: a tertiary care referral center (Johns Hopkins Hospital) and multiple equal-access medical centers (Shared Equal Access Regional Cancer Hospital [SEARCH] Database). METHODS. The data were retrospectively reviewed from men with biopsy Gleason sums 8 to 10 treated by radical prostatectomy at the Johns Hopkins Hospital (n = 220, 3.8% of total cohort) and within the SEARCH Database (n = 149, 7.7% of total cohort). The preoperative clinical characteristics predicting unfavorable pathologic disease (nonorgan-confined and/or positive surgical margins) and time to biochemical recurrence were determined using logistic regression and Cox proportional hazards analysis, respectively. RESULTS. Favorable pathologic outcome (organ-confined and negative surgical margins) was observed in 21% of the men in the Johns Hopkins cohort and 41% from the SEARCH cohort. On multivariate analysis, higher serum prostate-specific antigen (PSA) was the only variable that significantly predicted an unfavorable pathologic outcome from both the Johns Hopkins (P = .047) and SEARCH cohorts (P =.002). The 5-year and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 40% (95% confidence interval [CI], 33-48%) and 27% (95% CI, 18-36%), respectively, and 32% (95% CI, 22-42%) and 28% (95% CI, 18-38%) in the SEARCH cohort, respectively. Among men with favorable pathologic findings, the 5- and 10-year estimated biochemical-free survival rates in the Johns Hopkins cohort were 79% (95% CI, 62-89%) and 50% (95% CI, 25-71%), respectively, and 49% (95% CI, 32-65%) and 49% (95% CI, 32-65%) in the SEARCH cohort, respectively. No single preoperative variable significantly predicted the risk of biochemical progression in both the SEARCH or Johns Hopkins cohorts. CONCLUSIONS. The majority of men with a biopsy Gleason sum of ≥8, regardless of where the patient is treated, had unfavorable pathologic disease and experienced a biochemical progression after radical prostatectomy. Even among men with organ-confined disease and negative surgical margins or pathologic Gleason sum <8, at least half of the men experienced a PSA recurrence. Patients with biopsy Gleason sum 8 to 10 cancers are good candidates for multimodal therapy. Whereas multimodal therapy has often meant radiation plus hormonal therapy, newer possibilities for multimodal therapy exist such as surgery with neoadjuvant or adjuvant chemohormonal therapy or surgery with adjuvant radiation.

KW - Gleason score 8 to 10

KW - High risk

KW - Prostate cancer

KW - Radical prostatectomy

KW - Recurrence

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U2 - 10.1002/cncr.22116

DO - 10.1002/cncr.22116

M3 - Review article

VL - 107

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JO - Cancer

JF - Cancer

SN - 0008-543X

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