High-Grade Prostate Cancer: Favorable Results in the Modern Era Regardless of Initial Treatment

Abstract

Purpose. We performed a retrospective study to determine the outcome of a modern cohort of patients with high-grade (Gleason score ≥ 8) prostate cancer treated with radical prostatectomy, radiation therapy, or hormone therapy. Methods. We identified 404 patients in the South Texas Veteran's Healthcare System Tumor Registry diagnosed with high grade prostate cancer between 1998 and 2008. Mean follow-up was 4.62 ± 2.61 years. End points were biochemical failure-free survival, overall survival, metastasis-free survival, and cancer-specific survival. Results. 5-year overall survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 88.9%, 76.3%, and 58.9%, respectively. 5-year metastasis-free survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 96.8%, 96.6%, and 88.4%, respectively, and 5-year cancer-specific survival was 97.2%, 100%, and 89.9%, respectively. Patients with a Gleason score of 10 and pretreatment prostate-specific antigen > 20 ng/mL had decreased 5-year biochemical failure-free and cancer-specific survival. Patients with a pretreatment prostate-specific antigen > 20 ng/mL had decreased 5-year overall survival. Discussion. Even for patients with high-grade disease, the outcome is not as dire in the modern era regardless of primary treatment modality chosen. While there is room for improvement, we should not have a nihilistic impression of how these patients will respond to treatment.

Pelvic Radiotherapy versus Radical Prostatectomy with Limited Lymph Node Sampling for High-Grade Prostate Adenocarcinoma

“…However, the 5-year BF rate for the RT group is more than twice our calculated rate of 7.2%. This discrepancy is most likely due to 95.8% of RT patients in our study receiving ADT, compared to 50.8% in the referenced study [ 15 ]. RT with 2-3 years of ADT is now a NCCN category 1 recommendation for patients with a high-risk of recurrence [ 1 ] based on randomized trial data showing decreased rates of clinical progression and increased overall survival compared to patients not receiving ADT [ 17 ].…”

“…Even fewer studies have compared the biochemical and metastatic outcomes of patients with GS ≥ 8 disease treated with RP versus RT + ADT. Two retrospective studies have investigated outcomes of patients with GS ≥ 8 [ 15 , 16 ]. Ramahi et al reported 5-year distant metastasis and 5-year RP BF rates similar to our current study [ 15 ].…”

“…Two retrospective studies have investigated outcomes of patients with GS ≥ 8 [ 15 , 16 ]. Ramahi et al reported 5-year distant metastasis and 5-year RP BF rates similar to our current study [ 15 ]. However, the 5-year BF rate for the RT group is more than twice our calculated rate of 7.2%.…”