Gleason Score 10.

[pjoshea13]

New study below [1].

A GS=10 is rare, but that's no consolation to the men who receive the diagnosis.

However, a new study reports that:

"Aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease 5 years after treatment."

"The propensity score-adjusted 5-year overall survival rate was 80% for the RP group, 73% for the EBRT group, and 83% for the EBRT-BT (EBRT with a brachytherapy boost) group."

{Interesting that RP was so much better than EBRT.}

...

Some will recognize the team as having had a related paper published in JAMA this year [2]:

"Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer"

I bring it up because of this:

"The proportional hazard for time to all-cause mortality varied over time, with EBRT+BT associated with significantly improved overall survival before 7.5 years of follow-up, but with all cohorts having similar overall survival outcomes afterward. It is possible that this is reflective of a prostate cancer–specific mortality benefit to EBRT+BT emerging early, only to eventually dissipate as other-cause mortality increases over time."

It seems that EBRT+BT increases other-cause mortality in time. In the long-term, the survival advantage of EBRT+BT is illusionary.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/?te...

Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):883-888. doi: 10.1016/j.ijrobp.2018.03.060. Epub 2018 Apr 5.

Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results From a Multi-institutional Consortium Study.

Sandler KA1, Cook RR2, Ciezki JP3, Ross AE4, Pomerantz MM5, Nguyen PL6, Shaikh T7, Tran PT8, Stock RG9, Merrick GS10, Demanes DJ1, Spratt DE11, Abu-Isa EI11, Wedde TB12, Lilleby W12, Krauss DJ13, Shaw GK5, Alam R4, Reddy CA3, Song DY9, Klein EA3, Stephenson AJ3, Tosoian JJ4, Hegde JV1, Yoo SM1, Fiano R9, D'Amico AV5, Nickols NG14, Aronson WJ15, Sadeghi A16, Greco SC8, Deville C8, McNutt T8, DeWeese TL8, Reiter RE17, Said JW18, Steinberg ML1, Horwitz EM7, Kupelian PA1, King CR1, Kishan AU19.

Author information

1

Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California.

2

Department of Epidemiology, Fielding School of Public Health at UCLA, Los Angeles, California.

3

Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.

4

Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

5

Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.

6

Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.

7

Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.

8

Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.

9

Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York.

10

Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, West Virginia.

11

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.

12

Department of Oncology, Oslo University Hospital-Norwegian Radium Hospital, Norway.

13

William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan.

14

Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California; Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.

15

Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Urology, University of California, Los Angeles, Los Angeles, California.

16

Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.

17

Department of Urology, University of California, Los Angeles, Los Angeles, California.

18

Department of Pathology, University of California, Los Angeles, Los Angeles, California.

19

Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California. Electronic address: [e-mail].

Abstract

PURPOSE:

Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis of patients presenting with GS 10 PCa are largely unknown because of its rarity.

METHODS AND MATERIALS:

The study included 112 patients with biopsy-determined GS 10 PCa who received treatment with radical prostatectomy (RP, n = 26), external beam radiation therapy (EBRT, n = 48), or EBRT with a brachytherapy boost (EBRT-BT, n = 38) between 2000 and 2013. Propensity scores were included as covariates for comparative analysis. Overall survival, prostate cancer-specific survival, and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method with inverse probability of treatment weighting to control for confounding.

RESULTS:

The median follow-up period was 4.9 years overall (3.9 years for RP, 4.8 years for EBRT, and 5.7 years for EBRT-BT). Significantly more EBRT patients than EBRT-BT patients received upfront androgen deprivation therapy (98% vs 79%, P < .01 by χ2 test), though the durations were similar (median, 24 months vs 22.5 months). Of the RP patients, 34% received postoperative EBRT, and 35% received neoadjuvant systemic therapy. The propensity score-adjusted 5-year overall survival rate was 80% for the RP group, 73% for the EBRT group, and 83% for the EBRT-BT group. The corresponding adjusted 5-year prostate cancer-specific survival rates were 87%, 75%, and 94%, respectively. The EBRT-BT group trended toward superior DMFS when compared with the RP group (hazard ratio, 0.3; 95% confidence interval 0.1-1.06; P = .06) and had superior DMFS when compared with the EBRT group (hazard ratio, 0.4; 95% confidence interval 0.1-0.99; P = .048).

CONCLUSIONS:

To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy-determined GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease 5 years after treatment.

Copyright © 2018 Elsevier Inc. All rights reserved.

PMID: 29976500 DOI: 10.1016/j.ijrobp.2018.03.060

...

[2] ncbi.nlm.nih.gov/pmc/articl... [Full text]

[Dayatatime]

Great stuff Patrick and thank you for all that you do. It is becoming more apparent what an aggressive multimodal treatment approach will do. It seems slowly but surely we are putting the dark ages of this disease behind us. I can't stress enough how important it is to find a facility that does more than standard of care practice. Obviously it is still going to depend on the patient's individual case but it is well worth a specialists opinion. Guy's look beyond your hometown team and seek the possibilities that are out there. The word cure and Stage IV prostate cancer is becoming more of a reality if not that far advanced.

Ron

[Kat95]

Is the Gleason a reliable indicator of aggression? My husband’s Gleason was reported as 7 (4 + 3) yet his cancer is mega aggressive and no treatment has suppressed it for long. He failed ADT within 2 months and enzalutamide didn’t even get off the ground in terms of dropping the PSA level - it just continued to rise!

[larry_dammit]

Kat. Has he done chemo and ADT treatment. Sorry to hear about the monster 🙏🙏🙏🙏

[jsmith2506]

It doesn't mention whether this study included Stage IV with metastates…..or is this study only for localized Stage IV (is that possible?)

[Hidden in reply to jsmith2506]

Stage IV means that it is no longer local. Someone correct me if this is wrong.

[jsmith2506 in reply to Hidden]

Thanks so much for the reply.....

[pjoshea13 in reply to Hidden]

"Patients diagnosed with stage IV prostate cancer can be broadly divided into two groups. Patients with cancer locally confined to the pelvis, but involving adjacent organs or lymph nodes have localized stage IV or D1 prostate cancer. Patients with disease that has spread to distant organs, most commonly the spine, ribs, pelvis and other bones have metastatic stage IV or D2 prostate cancer."

texasoncology.com/types-of-...

-Patrick

[Hidden in reply to pjoshea13]

Thanks for that info. I was interpreting 'local' as confined to the prostate.

[benninger]

Thank You !! This gives us hope.