Long-term prognostic significance of primary gleason pattern in patients with gleason score 7 prostate cancer

Impact on prostate cancer specific survival

Matthew K. Tollefson, Bradley C. Leibovich, Jeffrey M. Slezak, Horst Zincke, Michael L. Blute

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Purpose: We determined the long-term clinical significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer. Materials and Methods: We reviewed the records of all patients who underwent bilateral pelvic lymph node dissection and radical retropubic prostatectomy for Gleason score 7 prostate cancer at our institution. All patients who underwent adjuvant hormonal or radiation therapy were excluded from analysis. Patients were monitored for biochemical failure, that is PSA progression, systemic recurrence and cancer specific survival. Results: We identified 1,688 patients who met admission criteria, of whom 1,256 (74.4%) had primary Gleason pattern 3 and 432 (25.6%) had primary Gleason pattern 4. Median followup was 6.9 years. At 10 years primary Gleason pattern 3 was associated with increased biochemical recurrence-free survival (48% vs 38%, p <0.001), lower systemic recurrence (8% vs 15%, p <0.001) and higher cancer specific survival (97% vs 93%, p = 0.013) for Gleason primary grades 3 and 4, respectively. All of these end points remained significant on multivariate analysis when controlling for preoperative PSA, seminal vesicle involvement, margin status, DNA ploidy and TNM staging. PSA doubling time was shorter in patients with primary Gleason pattern 4 (1.64 vs 1.01 years). Systemic recurrence and cancer specific survival were associated with a PSA doubling time of less than 1 year. Conclusions: Gleason score 7 prostate cancer is a heterogeneous entity. We should continue to stratify patients according to primary Gleason pattern. Patients with Gleason score 4 + 3 prostate cancer have more aggressive disease and experience higher rates of biochemical failure, systemic recurrence and cancer specific death.

Original languageEnglish (US)
Pages (from-to)547-551
Number of pages5
JournalJournal of Urology
Volume175
Issue number2
DOIs
StatePublished - Feb 2006

Fingerprint

Neoplasm Grading
Prostatic Neoplasms
Survival
Recurrence
Neoplasms
Seminal Vesicles
Neoplasm Staging
Ploidies
Prostatectomy
Lymph Node Excision
Radiotherapy
Multivariate Analysis
DNA

Keywords

  • Disease progression
  • Mortality
  • Prostate
  • Prostatectomy
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Long-term prognostic significance of primary gleason pattern in patients with gleason score 7 prostate cancer : Impact on prostate cancer specific survival. / Tollefson, Matthew K.; Leibovich, Bradley C.; Slezak, Jeffrey M.; Zincke, Horst; Blute, Michael L.

In: Journal of Urology, Vol. 175, No. 2, 02.2006, p. 547-551.

Research output: Contribution to journalArticle

Tollefson, Matthew K. ; Leibovich, Bradley C. ; Slezak, Jeffrey M. ; Zincke, Horst ; Blute, Michael L. / Long-term prognostic significance of primary gleason pattern in patients with gleason score 7 prostate cancer : Impact on prostate cancer specific survival. In: Journal of Urology. 2006 ; Vol. 175, No. 2. pp. 547-551.
@article{f3f6d25bb6ed4f99b13072446f000f19,
title = "Long-term prognostic significance of primary gleason pattern in patients with gleason score 7 prostate cancer: Impact on prostate cancer specific survival",
abstract = "Purpose: We determined the long-term clinical significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer. Materials and Methods: We reviewed the records of all patients who underwent bilateral pelvic lymph node dissection and radical retropubic prostatectomy for Gleason score 7 prostate cancer at our institution. All patients who underwent adjuvant hormonal or radiation therapy were excluded from analysis. Patients were monitored for biochemical failure, that is PSA progression, systemic recurrence and cancer specific survival. Results: We identified 1,688 patients who met admission criteria, of whom 1,256 (74.4{\%}) had primary Gleason pattern 3 and 432 (25.6{\%}) had primary Gleason pattern 4. Median followup was 6.9 years. At 10 years primary Gleason pattern 3 was associated with increased biochemical recurrence-free survival (48{\%} vs 38{\%}, p <0.001), lower systemic recurrence (8{\%} vs 15{\%}, p <0.001) and higher cancer specific survival (97{\%} vs 93{\%}, p = 0.013) for Gleason primary grades 3 and 4, respectively. All of these end points remained significant on multivariate analysis when controlling for preoperative PSA, seminal vesicle involvement, margin status, DNA ploidy and TNM staging. PSA doubling time was shorter in patients with primary Gleason pattern 4 (1.64 vs 1.01 years). Systemic recurrence and cancer specific survival were associated with a PSA doubling time of less than 1 year. Conclusions: Gleason score 7 prostate cancer is a heterogeneous entity. We should continue to stratify patients according to primary Gleason pattern. Patients with Gleason score 4 + 3 prostate cancer have more aggressive disease and experience higher rates of biochemical failure, systemic recurrence and cancer specific death.",
keywords = "Disease progression, Mortality, Prostate, Prostatectomy, Prostatic neoplasms",
author = "Tollefson, {Matthew K.} and Leibovich, {Bradley C.} and Slezak, {Jeffrey M.} and Horst Zincke and Blute, {Michael L.}",
year = "2006",
month = "2",
doi = "10.1016/S0022-5347(05)00152-7",
language = "English (US)",
volume = "175",
pages = "547--551",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Long-term prognostic significance of primary gleason pattern in patients with gleason score 7 prostate cancer

T2 - Impact on prostate cancer specific survival

AU - Tollefson, Matthew K.

AU - Leibovich, Bradley C.

AU - Slezak, Jeffrey M.

AU - Zincke, Horst

AU - Blute, Michael L.

PY - 2006/2

Y1 - 2006/2

N2 - Purpose: We determined the long-term clinical significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer. Materials and Methods: We reviewed the records of all patients who underwent bilateral pelvic lymph node dissection and radical retropubic prostatectomy for Gleason score 7 prostate cancer at our institution. All patients who underwent adjuvant hormonal or radiation therapy were excluded from analysis. Patients were monitored for biochemical failure, that is PSA progression, systemic recurrence and cancer specific survival. Results: We identified 1,688 patients who met admission criteria, of whom 1,256 (74.4%) had primary Gleason pattern 3 and 432 (25.6%) had primary Gleason pattern 4. Median followup was 6.9 years. At 10 years primary Gleason pattern 3 was associated with increased biochemical recurrence-free survival (48% vs 38%, p <0.001), lower systemic recurrence (8% vs 15%, p <0.001) and higher cancer specific survival (97% vs 93%, p = 0.013) for Gleason primary grades 3 and 4, respectively. All of these end points remained significant on multivariate analysis when controlling for preoperative PSA, seminal vesicle involvement, margin status, DNA ploidy and TNM staging. PSA doubling time was shorter in patients with primary Gleason pattern 4 (1.64 vs 1.01 years). Systemic recurrence and cancer specific survival were associated with a PSA doubling time of less than 1 year. Conclusions: Gleason score 7 prostate cancer is a heterogeneous entity. We should continue to stratify patients according to primary Gleason pattern. Patients with Gleason score 4 + 3 prostate cancer have more aggressive disease and experience higher rates of biochemical failure, systemic recurrence and cancer specific death.

AB - Purpose: We determined the long-term clinical significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer. Materials and Methods: We reviewed the records of all patients who underwent bilateral pelvic lymph node dissection and radical retropubic prostatectomy for Gleason score 7 prostate cancer at our institution. All patients who underwent adjuvant hormonal or radiation therapy were excluded from analysis. Patients were monitored for biochemical failure, that is PSA progression, systemic recurrence and cancer specific survival. Results: We identified 1,688 patients who met admission criteria, of whom 1,256 (74.4%) had primary Gleason pattern 3 and 432 (25.6%) had primary Gleason pattern 4. Median followup was 6.9 years. At 10 years primary Gleason pattern 3 was associated with increased biochemical recurrence-free survival (48% vs 38%, p <0.001), lower systemic recurrence (8% vs 15%, p <0.001) and higher cancer specific survival (97% vs 93%, p = 0.013) for Gleason primary grades 3 and 4, respectively. All of these end points remained significant on multivariate analysis when controlling for preoperative PSA, seminal vesicle involvement, margin status, DNA ploidy and TNM staging. PSA doubling time was shorter in patients with primary Gleason pattern 4 (1.64 vs 1.01 years). Systemic recurrence and cancer specific survival were associated with a PSA doubling time of less than 1 year. Conclusions: Gleason score 7 prostate cancer is a heterogeneous entity. We should continue to stratify patients according to primary Gleason pattern. Patients with Gleason score 4 + 3 prostate cancer have more aggressive disease and experience higher rates of biochemical failure, systemic recurrence and cancer specific death.

KW - Disease progression

KW - Mortality

KW - Prostate

KW - Prostatectomy

KW - Prostatic neoplasms

UR - http://www.scopus.com/inward/record.url?scp=30344481399&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=30344481399&partnerID=8YFLogxK

U2 - 10.1016/S0022-5347(05)00152-7

DO - 10.1016/S0022-5347(05)00152-7

M3 - Article

VL - 175

SP - 547

EP - 551

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 2

ER -