366 BIOPSY-DETECTED GLEASON PATTERN 5 PREDICTS RECURRENCE IN MEN WITH HIGH-RISK PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Staging (II)1 Apr 2013366 BIOPSY-DETECTED GLEASON PATTERN 5 PREDICTS RECURRENCE IN MEN WITH HIGH-RISK PROSTATE CANCER Sean Stroup, Daniel Moreira, Leah Gerber, Stephen Freedland, Fred Millard, Martha Terris, William Aronson, Joseph Presti, Christopher Amling, and Christopher Kane Sean StroupSean Stroup San Diego, CA More articles by this author , Daniel MoreiraDaniel Moreira New Hyde Park, NY More articles by this author , Leah GerberLeah Gerber Durham, NC More articles by this author , Stephen FreedlandStephen Freedland Durham, NC More articles by this author , Fred MillardFred Millard La Jolla, CA More articles by this author , Martha TerrisMartha Terris Augusta, GA More articles by this author , William AronsonWilliam Aronson Los Angeles, CA More articles by this author , Joseph PrestiJoseph Presti Palo Alto, CA More articles by this author , Christopher AmlingChristopher Amling Portland, OR More articles by this author , and Christopher KaneChristopher Kane La Jolla, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1754AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to evaluate the relative risk of biochemical recurrence, bone metastases, and risk of death from prostate cancer contributed by biopsy Gleason pattern 5 among high-risk men with Gleason 8-10 disease in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. METHODS Men with biopsy Gleason sum 8-10 prostate cancer treated with radical prostatectomy were evaluated. The cohort was divided: Gleason 4+4, and those with any pattern 5 (i.e., Gleason 4+5, 5+3, 5+4, and 5+5; men with Gleason 3+5 were not included). Biochemical recurrence was defined as PSA >0.2ng/mL, 2 values at 0.2ng/mL, or secondary treatment for an elevated PSA. Predictors of PSA recurrence, development of bone metastases, prostate cancer-specific survival, and overall survival were analyzed using Kaplan-Meier, log-rank test and Cox proportional hazards model. RESULTS Of 3499 men in the SEARCH database, 255 (7%) met criteria for inclusion. Of these, 99 (39%) had Gleason 4+4, and 156 (61%) had Gleason pattern 5 on biopsy. On univariable analysis, relative to Gleason 4+4, men with any Gleason pattern 5 had a higher rate of biochemical recurrence (P<0.001), development of bone metastases (P<0.001), prostate cancer-specific mortality (P=0.009), and a trend towards worse overall survival (P=0.083, Figure). On multivariable analysis, men with Gleason pattern 5 had a higher rate of biochemical recurrence (HR=1.75; 95%CI=1.17-2.59; P=0.006) and development of bone metastases (HR=4.64; 95%CI=1.48–14.60; P=0.009), and similar cancer-specific (HR=2.11; 95%CI=0.59–7.53; P=0.247) and overall survival (HR=1.51; 95%CI=0.88–2.60; P=0.134). CONCLUSIONS Subclassification of high risk prostate cancer by biopsy Gleason grading (4+4 vs. presence of any Gleason pattern 5) can identify men at highest risk of prostate cancer progression and mortality. Presence of any Gleason pattern 5 cancer on biopsy portends a poor prognosis and negatively impacts survival. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e148 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Stroup San Diego, CA More articles by this author Daniel Moreira New Hyde Park, NY More articles by this author Leah Gerber Durham, NC More articles by this author Stephen Freedland Durham, NC More articles by this author Fred Millard La Jolla, CA More articles by this author Martha Terris Augusta, GA More articles by this author William Aronson Los Angeles, CA More articles by this author Joseph Presti Palo Alto, CA More articles by this author Christopher Amling Portland, OR More articles by this author Christopher Kane La Jolla, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...