Updated grading system predicts survival after surgery for prostate cancer with high Gleason score


By David L. Levine

NEW YORK (Reuters Health) - A new prostate cancer grading system (PCGS) predicts survival rates after radical prostatectomy for men with high-Gleason score (GS) disease, researchers have found.

The system divides prostate cancers into GS 8 versus GS 9-10 disease based on biochemical recurrence after surgery or radiation therapy, explained Dr. Misop Han of Johns Hopkins Medical Institutions in Baltimore, Maryland, who worked on the study.

"We were surprised by how well the updated PCGS predicted survival after surgery for men with high-Gleason score prostate cancer, even after adjusting for other known predictors of survival," Dr. Han told Reuters Health by email. "Men with GS 8 survived much (longer) after surgery than those with GS 9-10."

For the study, online November 19 in European Urology, Dr. Han and colleagues reviewed data for nearly 24,000 men undergoing radical prostatectomy (RP) at Johns Hopkins between 1984 and 2014. After excluding patients with biopsy, incomplete clinicopathologic or follow-up data, or a history of neoadjuvant treatment, there were 721 men with biopsy Gleason Score 8-10, and 1,047 men with RP Gleason score 8-10.

After a median follow-up of four years, 221 men with RP Gleason score 8-10 had died, 151 of them from prostate cancer. Compared with men with GS 8, those with GS 9-10 had a later radical prostatectomy year and a higher pathologic stage.

Prostate cancer-specific survival rates were significantly lower for men with GS 9-10 compared to men with GS 8, both for biopsy GS (hazard ratio, 2.13) and RP GS (HR, 2.38). This held true after adjusting for perioperative variables.

Dr. Han said the "results should give much hope for patients with high GS considering treatment. Even in those with high Gleason scores, there are a subgroup of men who survived much longer after surgery."

He cautioned that the study has limitations, such as being retrospective and done at a single institution. "It will be ideal if we can validate our findings on multi-institutional surgical and radiation therapy patients," Dr. Han said.

Dr. Otis Brawley, chief medical officer for the American Cancer Society, told Reuters Health by email that the new work "is a part of the advancement in prostate cancer pathology over the past ten years that is leading to less men being treated and more men watched."

The authors reported no funding or conflicts of interest. Dr. Jonathan I. Epstein, also at Johns Hopkins and a co-author of the report, helped develop the new grading system.

SOURCE: bit.ly/2gyGwiV

Eur Urol 2016.

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