Prostate cancer: adjuvant radiotherapy may not be suitable for Gleason score 8-10

  • Heo JE & al.
  • Medicine (Baltimore)
  • 1 Oct 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with high-grade prostate cancer undergoing radical prostatectomy (RP), those with Gleason score (GS) 8-10 and pathologic stage T2 (pT2) show higher biochemical recurrence (BCR) and cancer-specific mortality vs those with GS 7 and pT3.

Why this matters

  • In patients with high adverse features, guidelines recommend adjuvant radiotherapy without considering the GS at the time of RP.

Study design

  • Study of 1585 men with prostate cancer who underwent RP divided into 3 groups:
    • group 1 (GS 3+4 and pT3; n=760),
    • group 2 (GS 4+3 and pT3; n=565), and
    • group 3 (GS 8-10 and pT2; n=260).
  • Funding: No external funding.

Key results

  • Median follow-up of 58 months.
  • 721 men had BCR and 84 cancer-specific deaths were reported.
  • In groups 1, 2, and 3:
    • 10-year BCR-free survival rates were 50.9%, 33.2%, and 28.6%, respectively.
    • 15-year all-cause mortality rates were 27.2%, 25.6%, and 50.8%, respectively.
    • 15-year cancer-specific mortality rates were 2.1%, 8.9%, and 42.6%, respectively.
  • BCR-free survival was significantly lower in group 3 vs group 1 (P<.001 but similar vs group>
  • All-cause mortality was not significantly different between groups.
  • Cancer-specific survival was significantly lower in group 3 vs groups 1 (P=.001) and 2 (P=.005).

Limitations

  • Retrospective design.

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