Premium
A gleason score of 7 predicts a worse outcome for prostate carcinoma patients treated with radiotherapy
Author(s) -
Green Garth A.,
Hanlon Alexandra L.,
AlSaleem Tahseen,
Hanks Gerald E.
Publication year - 1998
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19980901)83:5<971::aid-cncr24>3.0.co;2-r
Subject(s) - medicine , prostate cancer , urology , prostate , univariate analysis , radiation therapy , stage (stratigraphy) , multivariate analysis , cancer , surgery , paleontology , biology
BACKGROUND In most reported surgical series, prostate carcinoma patients with a Gleason score of 7 have had worse outcomes than those with other moderately differentiated cancers. Because of variations in reporting grade and grouping Gleason scores, radiation series have conflicting results. METHODS Five hundred sixty‐three men with clinical Stage T1‐T3, N0 or Nx, M0 adenocarcinoma of the prostate and known pretreatment prostate specific (PSA) levels received external beam radiation only. The median pretreatment PSA was 10.3 ng/mL (range, 0.2‐191 ng/mL). The median duration of follow‐up was 42 months (range, 2‐114 months). Survival without biochemical failure (bNED) was defined as PSA ≤1.5 ng/mL and not rising when measured on two consecutive occasions. RESULTS The 5‐year rate of bNED control for all 563 patients was 62%. Increasing Gleason score predicted for decreased bNED control (78% for 2‐4, 63% for 5‐6, 37% for 7, and 33% for 8‐10 at 5 years; P = 0.0001 for overall comparison). The bNED control rate for patients with a Gleason score of 7 was significantly less than the rate for those with Gleason 5‐6 in both univariate ( P = 0.0008) and multivariate ( P = 0.0068) analysis. T classification by palpation, pretreatment PSA, and dose were also shown to be independent predictors of bNED control in multivariate analysis. CONCLUSIONS Even after adjustment for other known prognostic factors, a Gleason score of 7 was associated with worse bNED control than Gleason scores of 2‐4 and 5‐6 among patients treated with external beam radiotherapy only for clinically localized prostate carcinoma. Patients with a Gleason score of 7 should not be lumped together with those who have a Gleason score of 5‐6; they may instead benefit from more aggressive treatment strategies. [See editorial on pages 835‐6, this issue.] Cancer 1998;83:971‐976. © 1998 American Cancer Society.