Abstract
Purpose
A Gleason score ≥ 8, metastatic tumor burden, and visceral metastasis are known prognostic factors for patients with metastatic hormone-sensitive prostate cancer (mHSPC). Notably, however, these indicators have not been fully validated internationally. We aimed in this present study to further analyze the factors that influence the prognosis of mHSPC.
Methods
In this retrospective study, we identified 201 patients with newly diagnosed mHSPC between 2008 and 2014 and collected their clinical information. Cox proportional hazard regression models were used to identify prognostic factors in mHSPC.
Results
The mean age of the patients at presentation was 70 years (interquartile range (IQR), 64–76 years). The prostate-specific antigen level was 141 ng/mL (IQR, 58.8–464.5 ng/mL). Of the 201 study patients, 191 (94.5%) and 131 (65.2%) cases had a biopsy Gleason score ≥ 8 and grade 5, respectively. More than 4 metastases were detected in 134 patients. Castration-resistant prostate cancer (CRPC) was evident in 160 cases after a mean follow-up period of 46.6 months. By multivariable analysis, a Gleason grade of 5 and bone metastasis lesion count ≥ 4 were found to be significantly associated with CRPC-free survival (hazard ratio (HR), 1.45; 95% confidence interval (CI), 1.01–2.07) and (HR 2.02; 95% CI 1.39–2.92) and overall survival (HR 1.67 95%; CI 1.16–2.42) and (HR 1.67 95%; CI 1.16–2.41).
Conclusions
Bone metastases ≥ 4 and a Gleason grade 5 are independent prognostic factors for CRPC-free and overall survival in mHSPC. A Gleason grade 5 is therefore a new prognostic indicator in mHSPC.
Similar content being viewed by others
Availability of data and materials
Available from the corresponding author upon reasonable request.
Code availability
Not applicable.
References
Armstrong AJ et al (2019) ARCHES: a randomized, phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone-sensitive prostate cancer. J Clin Oncol 37:2974–2986. https://doi.org/10.1200/JCO.19.00799
Bolla M et al (2009) Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med 360:2516–2527. https://doi.org/10.1056/NEJMoa0810095
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492
Buelens S et al (2018) Metastatic burden in newly diagnosed hormone-naive metastatic prostate cancer: comparing definitions of CHAARTED and LATITUDE trial. Urol Oncol 36:158 e113-158 e120. https://doi.org/10.1016/j.urolonc.2017.12.009
Buzzoni C et al (2015) Metastatic prostate cancer incidence and prostate-specific antigen testing: new insights from the European randomized study of screening for prostate cancer. Eur Urol 68:885–890. https://doi.org/10.1016/j.eururo.2015.02.042
Crawford ED, Higano CS, Shore ND, Hussain M, Petrylak DP (2015) Treating patients with metastatic castration resistant prostate cancer: a comprehensive review of available therapies. J Urol 194:1537–1547. https://doi.org/10.1016/j.juro.2015.06.106
D’Amico AV (2016) Is Gleason grade 5 prostate cancer resistant to conventional androgen deprivation therapy? Eur Urol 69:761–763. https://doi.org/10.1016/j.eururo.2015.08.057
Damodaran S, Kyriakopoulos CE, Jarrard DF (2017) Newly diagnosed metastatic prostate cancer: has the paradigm changed? Urol Clin N Am 44:611–621. https://doi.org/10.1016/j.ucl.2017.07.008
Denham JW et al (2014) Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): an open-label, randomised, phase 3 factorial trial. Lancet Oncol 15:1076–1089. https://doi.org/10.1016/S1470-2045(14)70328-6
Herlemann A, Washington SL 3rd, Cooperberg MR (2019) Health care delivery for metastatic hormone-sensitive prostate cancer across the globe. Eur Urol Focus 5:155–158. https://doi.org/10.1016/j.euf.2018.12.003
Horwitz EM et al (2008) Ten-year follow-up of radiation therapy oncology group protocol 92–02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol 26:2497–2504. https://doi.org/10.1200/JCO.2007.14.9021
Huggins C, Hodges CV (2002) Studies on prostatic cancer. I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate 1941. J Urol 167:948–951; discussion 952
Iacovelli R et al (2018) Comparison between prognostic classifications in de novo metastatic hormone sensitive prostate cancer. Target Oncol 13:649–655. https://doi.org/10.1007/s11523-018-0588-8
James ND et al (2017) Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med 377:338–351. https://doi.org/10.1056/NEJMoa1702900
Kelly SP, Anderson WF, Rosenberg PS, Cook MB (2018) Past, current, and future incidence rates and burden of metastatic prostate cancer in the United States. Eur Urol Focus 4:121–127. https://doi.org/10.1016/j.euf.2017.10.014
Kwon WA et al (2019) Use of docetaxel plus androgen deprivation therapy for metastatic hormone-sensitive prostate cancer in Korean patients: a retrospective study. Investig Clin Urol 60:195–201. https://doi.org/10.4111/icu.2019.60.3.195
Kyriakopoulos CE et al (2018) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer: long-term survival analysis of the randomized phase III E3805 CHAARTED Trial. J Clin Oncol 36:1080–1087. https://doi.org/10.1200/JCO.2017.75.3657
Lee JL et al (2010) Efficacy and safety of docetaxel plus prednisolone chemotherapy for metastatic hormone-refractory prostate adenocarcinoma: single institutional study in Korea. Cancer Res Treat 42:12–17. https://doi.org/10.4143/crt.2010.42.1.12
Sato H et al (2018) Impact of early changes in serum biomarkers following androgen deprivation therapy on clinical outcomes in metastatic hormone-sensitive prostate cancer. BMC Urol 18:32. https://doi.org/10.1186/s12894-018-0353-4
Scher HI et al (2008) Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 26:1148–1159. https://doi.org/10.1200/JCO.2007.12.4487
Sharifi N, Dahut WL, Steinberg SM, Figg WD, Tarassoff C, Arlen P, Gulley JL (2005) A retrospective study of the time to clinical endpoints for advanced prostate cancer. BJU Int 96:985–989. https://doi.org/10.1111/j.1464-410X.2005.05798.x
Stroup SP et al (2017) Biopsy detected Gleason pattern 5 is associated with recurrence, metastasis and mortality in a cohort of men with high risk prostate cancer. J Urol 198:1309–1315. https://doi.org/10.1016/j.juro.2017.07.009
Sweeney CJ et al (2015) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 373:737–746. https://doi.org/10.1056/NEJMoa1503747
Funding
This research did not receive any specific funding from the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
Study conception and design BL, C-SK; data acquisition YSK, WL; data analysis and interpretation DY, IGJ; manuscript drafting BL; critical manuscript revisions JHH, HA, and supervision C-SK.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they do not have any conflict of interest.
Ethics approval
The requirement for patient informed consent was waived by the Institutional Review Board of Asan Medical Center.
Consent for publication
All patients whose data were retrospectively analyzed were informed of the use of their clinical information under anonymization and received an opportunity to object to use or publication.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lim, B., Lee, W., Kyung, Y.S. et al. Biopsy-detected Gleason grade 5 tumor is an additional prognostic factor in metastatic hormone-sensitive prostate cancer. J Cancer Res Clin Oncol 148, 727–734 (2022). https://doi.org/10.1007/s00432-021-03642-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-021-03642-2