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Impact of Gleason pattern 5 including tertiary pattern 5 on outcomes of salvage treatment for biochemical recurrence in pT2-3N0M0 prostate cancer

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Abstract

Background

Gleason pattern 5 (GP5), including tertiary GP5, at radical prostatectomy has reportedly been associated with poorer clinical outcome. However, it is undetermined how tertiary GP5 is handled in the new Gleason grade grouping starting in 2016, and its prognostic value in patients undergoing salvage treatment for postoperative biochemical recurrence (BCR) remains unclear.

Methods

We retrospectively reviewed 116 patients with pT2-3N0M0 prostate cancer (PC) who received salvage treatment for BCR after radical prostatectomy between 2003 and 2014. The primary endpoint was failure of salvage treatment, defined as a single prostate-specific antigen (PSA) value ≥0.2 ng/ml after PSA nadir following salvage treatment. Associations of various clinicopathological factors, including GP5, with failure-free survival were assessed. Cox proportional hazards model was used for multivariate analysis.

Results

Patients received salvage treatment with either radiotherapy (n = 48), androgen-deprivation therapy (n = 61), or both (n = 7) for BCR. Twenty-three patients (19.8 %) experienced failure of salvage treatment, with a median follow-up period of 79 months. Univariate analysis associated GP5, Gleason score-based parameters, lymphovascular invasion, and PSA doubling time <6 months with poorer failure-free survival. Receiver operating characteristic curve analyses identified the area under the curve for GP5 (0.654) as the largest among those parameters (P = 0.0060). Multivariate analysis demonstrated that GP5 was the only independent predictor of poor outcome.

Conclusions

The presence of GP5 is an independent predictor of poor prognosis in patients with pT2-3N0M0 PC undergoing salvage treatment for BCR after radical prostatectomy. GP5 may thus be a more useful marker than conventional Gleason score in this setting.

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References

  1. Hull GW, Rabbani F, Abbas F et al (2002) Cancer control with radical prostatectomy alone in 1000 consecutive patients. J Urol 167:528–534

    Article  PubMed  Google Scholar 

  2. Roehl KA, Han M, Ramos CG et al (2004) Cancer progression and survival rates following anatomical radical retro-pubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 172:910–914

    Article  PubMed  Google Scholar 

  3. Akaza H, Umbas R (2013) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)—Asia Consensus Statement: Prostate Cancer Version 2.2013. Reno Medical KK, Tokyo

  4. Stephenson AJ, Scardino PT, Kattan MW et al (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25:2035–2041

    Article  PubMed  PubMed Central  Google Scholar 

  5. Goenka A, Magsanoc JM, Pei X et al (2012) Long-term outcomes after high-dose postprostatectomy salvage radiation treatment. Int J Radiat Oncol Biol Phys 84:112–118

    Article  PubMed  Google Scholar 

  6. Moul JW, Wu H, Sun L et al (2004) Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy. J Urol 171:1141–1147

    Article  PubMed  Google Scholar 

  7. Siddiqui SA, Boorjian SA, Inman B et al (2008) Timing of androgen deprivation therapy and its impact on survival after radical prostatectomy: a matched cohort study. J Urol 179:1830–1837

    Article  PubMed  Google Scholar 

  8. Cheng L, Koch MO, Juliar BE et al (2005) The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy. J Clin Oncol 23:2911–2917

    Article  PubMed  Google Scholar 

  9. Patel AA, Chen MH, Renshaw AA et al (2007) PSA failure following definitive treatment of prostate cancer having biopsy Gleason score 7 with tertiary grade 5. JAMA 298:1533–1538

    CAS  PubMed  Google Scholar 

  10. Vis AN, Roemeling S, Kranse R et al (2007) Should we replace the Gleason score with the amount of high-grade prostate cancer? Eur Urol 51:931–939

    Article  CAS  PubMed  Google Scholar 

  11. Sim HG, Telesca D, Culp SH et al (2008) Tertiary Gleason pattern 5 in Gleason 7 prostate cancer predicts pathological stage and biochemical recurrence. J Urol 179:1775–1779

    Article  PubMed  Google Scholar 

  12. Trock BJ, Guo CC, Gonzalgo ML et al (2009) Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system. J Urol 182:1364–1370

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nanda A, Chen MH, Renshaw AA et al (2009) Gleason Pattern 5 prostate cancer: further stratification of patients with high-risk disease and implications for future randomized trials. Int J Radiat Oncol Biol Phys 74:1419–1423

    Article  PubMed  Google Scholar 

  14. Sabolch A, Feng FY, Daignault-Newton S et al (2011) Gleason pattern 5 is the greatest risk factor for clinical failure and death from prostate cancer after dose-escalated radiation therapy and hormonal ablation. Int J Radiat Oncol Biol Phys 81:e351–e360

    Article  PubMed  Google Scholar 

  15. Hashine K, Yuasa A, Shinomori K et al (2011) Tertiary Gleason pattern 5 and oncological outcomes after radical prostatectomy. Jpn J Clin Oncol 41:571–576

    Article  PubMed  Google Scholar 

  16. Song C, Kim YS, Hong JH et al (2010) Treatment failure and clinical progression after salvage therapy in men with biochemical recurrence after radical prostatectomy: radiotherapy vs. androgen deprivation. BJU Int 106:188–193

    Article  PubMed  Google Scholar 

  17. Jackson W, Hamstra DA, Johnson S et al (2013) Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer-specific death in patients receiving salvage radiation therapy following radical prostatectomy. Cancer (Phila) 119:3287–3294

    Article  Google Scholar 

  18. Adam M, Hannah A, Budäus L et al (2014) A tertiary Gleason pattern in the prostatectomy specimen and its association with adverse outcome after radical prostatectomy. J Urol 192:97–101

    Article  PubMed  Google Scholar 

  19. Lucca I, Shariat SF, Briganti A, et al (2015) Validation of tertiary Gleason pattern 5 in Gleason score 7 prostate cancer as an independent predictor of biochemical recurrence and development of a prognostic model. Urol Oncol 33:71.e21–71.e26

  20. Pierorazio PM, Walsh PC, Partin AW et al (2013) Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 111:753–760

    Article  PubMed  PubMed Central  Google Scholar 

  21. Epstein JI, Egevad L, Amin MB, Grading Committee et al (2016) The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40:244–252

    PubMed  Google Scholar 

  22. Hirao Y (2012) Clinical Practice Guidelines for Prostate Cancer: The Japanese Urological Association 2012 update (in Japanese). Kanehara-shuppan Press, Tokyo

    Google Scholar 

  23. Roberts SG, Blute ML, Bergstralh EJ et al (2001) PSA doubling time as a predictor of clinical progression after biochemical failure following radical prostatectomy for prostate cancer. Mayo Clinic Proc 76:576–581

    Article  CAS  Google Scholar 

  24. Epstein JI, Allsbrook WC Jr, Grading Amin MB ISUP, ISUP Grading Committee et al (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29:1228–1242

    Article  PubMed  Google Scholar 

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Acknowledgments

We received no funding/grant support for this study.

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Authors and Affiliations

  1. Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Satoru Taguchi, Hiroshi Fukuhara, Akihiro Naito, Shigenori Kakutani, Yuta Takeshima, Hideyo Miyazaki, Tohru Nakagawa, Tetsuya Fujimura, Haruki Kume & Yukio Homma

  2. Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kenshiro Shiraishi & Keiichi Nakagawa

  3. Department of Pathology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Teppei Morikawa

Authors
  1. Satoru Taguchi
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  2. Kenshiro Shiraishi
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  3. Hiroshi Fukuhara
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  11. Tetsuya Fujimura
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  12. Haruki Kume
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  13. Yukio Homma
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Corresponding author

Correspondence to Hiroshi Fukuhara.

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The authors declare that they have no competing interests.

Electronic supplementary material

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10147_2016_978_MOESM1_ESM.bmp

Kaplan–Meier curves depicting failure-free survival according to salvage treatment modalities (log-rank test, P=0.0783) (BMP 16731 kb)

10147_2016_978_MOESM2_ESM.bmp

Receiver operating characteristic (ROC) curves of three Gleason score (GS)-related variables, among which the area under the curve (AUC) for Gleason pattern 5 (GP5) was the largest (AUC=0.654, P=0.0060) (BMP 13999 kb)

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Taguchi, S., Shiraishi, K., Fukuhara, H. et al. Impact of Gleason pattern 5 including tertiary pattern 5 on outcomes of salvage treatment for biochemical recurrence in pT2-3N0M0 prostate cancer. Int J Clin Oncol 21, 975–980 (2016). https://doi.org/10.1007/s10147-016-0978-9

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  • DOI: https://doi.org/10.1007/s10147-016-0978-9

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