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Men with biopsy Gleason score 7, tertiary grade 5 disease face similar risk of PSA recurrence as men with higher Gleason score disease, study data suggest

Monday, November 12 2007 | Comments

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What's This? Men with prostate cancer with a biopsy Gleason score of 7 and a tertiary grade 5 may face a risk of prostate-specific antigen failure similar to that of men whose tumors have a Gleason score of 8 to 10, study data indicate.

Researchers examined data from 2,370 men with clinical tumor category 1c to 3b, node-negative, and nonmetastatic prostate cancer who underwent definitive therapy from 1989 to 2005. Pathologist-assigned Gleason scores were evaluated to determine whether the presence of a tertiary grade 5 in men with Gleason score 7 disease is associated with shorter time to PSA failure.

Results showed a median time to PSA failure of 5.0 years among men with Gleason score 7 and tertiary grade 5 disease compared with 5.1 years among those with Gleason scores 8 to 10, 6.7 years for men with Gleason score 7 without tertiary grade 5 disease, and 15.4 years for men with Gleason score 6 or less disease.

In multivariate analysis that adjusted for known prognostic factors and propensity score, The time to PSA failure among men with biopsy Gleason score 7 and tertiary grade 5 disease was significantly shorter than that of men with biopsy Gleason score 7 without tertiary grade 5 disease (HR, 0.56; 95% CI, 0.23-0.97; P=.04) and men with biopsy Gleason score 6 or less disease (HR, 0.24; 95% CI, 0.13-0.43; P<.001). In contrast, time to PSA failure among men with biopsy Gleason score 7 and tertiary grade 5 disease was not significantly different from that of men whose tumors had biopsy Gleason scores of 8 to 10 (HR, 0.96; 95% CI, 0.54-1.71; P=.9).

Furthermore, with a median follow-up time of 4.2 years, 5-year estimates of PSA recurrence were significantly greater among men with biopsy Gleason score 7 with tertiary grade 5 disease (56%; 95% CI, 37%-77%) than among those with Gleason score 7 without tertiary grade 5 disease (33%; 95% CI, 29%-37%; P=.01) and those with Gleason score 6 or less disease (21%; 95% CI, 18%-25%; P<.001), but were not significantly different from those of men whose tumors had biopsy Gleason scores of 8 to 10 (50%; 95% CI, 43%-57%; P=.57).

If validated by additional studies in other populations, these findings may suggest a need to manage patients with Gleason score 7 with tertiary grade 5 disease similarly to patients with higher Gleason score disease and consider them for enrollment in clinical trials for which men with higher Gleason score disease are eligible, the authors concluded. (Patel AA, et al. JAMA 2007;298:1533-1538.)

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