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Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4.
J Urol. 2001 Nov; 166(5):1692-7.JU

Abstract

PURPOSE

We evaluated differences in clinical and pathological outcomes between Gleason 3 + 4 and 4 + 3 prostate cancer.

MATERIALS AND METHODS

The radical prostatectomy whole mounted specimens from 263 men with pathological Gleason 7 tumors were identified. Gleason 3 + 4 and 4 + 3 tumors were compared in regard to pathological variables and outcome. Significance of clinical and pathological data on progression-free survival was analyzed.

RESULTS

Of the tumors 34% had a primary Gleason grade of 4, and were more likely than those with primary grade 3 to have seminal vesicle involvement (34% versus 18%, p = 0.006), a higher pathological stage (pT3 55% versus 42%, N+ 13% versus 3%, 0.001), extraprostatic extension (58% versus 38%, 0.001) and higher median preoperative prostate specific antigen (PSA) (13.5 versus 9.0 ng./ml., respectively <0.001). Mean followup plus or minus standard deviation was 6.8 +/- 1.9 years. The overall 10-year crude, cancer specific and progression-free survival rates were 83%, 99% and 58%, respectively. Primary Gleason grade was significantly associated with progression-free (risk ratio 1.6, 95% confidence interval 1.08 to 2.5, p = 0.02) but not crude and cancer-specific survival. Univariately, primary Gleason grade 4 was associated with progression-free survival, as were percent Gleason 4, seminal vesicle invasion, lymph node involvement, pT stage, margin status, DNA ploidy, preoperative PSA, cancer volume and extent of extraprostatic extension. Multivariately, only preoperative PSA (p <0.001), seminal vesicle invasion (<0.001) and DNA ploidy (0.002) were associated with progression-free survival. Primary Gleason grade and percent Gleason 4 were not identified as independently associated with progression-free survival.

CONCLUSIONS

In patients with Gleason 7 score prostate cancer primary Gleason grade 3 and 4 cancers are different in pathological parameters and prognosis. However, primary Gleason grade does not provide any additional information than other known prognostic factors, such as preoperative PSA, seminal vesicle invasion and DNA ploidy.

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Authors+Show Affiliations

Lau WK
Department of Urology, Laboratory Medicine and Pathology, Section of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA.
Blute ML
No affiliation info available
Bostwick DG
No affiliation info available
Weaver AL
No affiliation info available
Sebo TJ
No affiliation info available
Zincke H
No affiliation info available

MeSH

AdenocarcinomaAgedHumansMaleMiddle AgedNeoplasm StagingPrognosisProstate-Specific AntigenProstatic NeoplasmsSeminal VesiclesSurvival Analysis

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11586204

Citation

Lau, W K., et al. "Prognostic Factors for Survival of Patients With Pathological Gleason Score 7 Prostate Cancer: Differences in Outcome Between Primary Gleason Grades 3 and 4." The Journal of Urology, vol. 166, no. 5, 2001, pp. 1692-7.
Lau WK, Blute ML, Bostwick DG, et al. Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4. J Urol. 2001;166(5):1692-7.
Lau, W. K., Blute, M. L., Bostwick, D. G., Weaver, A. L., Sebo, T. J., & Zincke, H. (2001). Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4. The Journal of Urology, 166(5), 1692-7.
Lau WK, et al. Prognostic Factors for Survival of Patients With Pathological Gleason Score 7 Prostate Cancer: Differences in Outcome Between Primary Gleason Grades 3 and 4. J Urol. 2001;166(5):1692-7. PubMed PMID: 11586204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4. AU - Lau,W K, AU - Blute,M L, AU - Bostwick,D G, AU - Weaver,A L, AU - Sebo,T J, AU - Zincke,H, PY - 2001/10/5/pubmed PY - 2001/11/3/medline PY - 2001/10/5/entrez SP - 1692 EP - 7 JF - The Journal of urology JO - J Urol VL - 166 IS - 5 N2 - PURPOSE: We evaluated differences in clinical and pathological outcomes between Gleason 3 + 4 and 4 + 3 prostate cancer. MATERIALS AND METHODS: The radical prostatectomy whole mounted specimens from 263 men with pathological Gleason 7 tumors were identified. Gleason 3 + 4 and 4 + 3 tumors were compared in regard to pathological variables and outcome. Significance of clinical and pathological data on progression-free survival was analyzed. RESULTS: Of the tumors 34% had a primary Gleason grade of 4, and were more likely than those with primary grade 3 to have seminal vesicle involvement (34% versus 18%, p = 0.006), a higher pathological stage (pT3 55% versus 42%, N+ 13% versus 3%, 0.001), extraprostatic extension (58% versus 38%, 0.001) and higher median preoperative prostate specific antigen (PSA) (13.5 versus 9.0 ng./ml., respectively <0.001). Mean followup plus or minus standard deviation was 6.8 +/- 1.9 years. The overall 10-year crude, cancer specific and progression-free survival rates were 83%, 99% and 58%, respectively. Primary Gleason grade was significantly associated with progression-free (risk ratio 1.6, 95% confidence interval 1.08 to 2.5, p = 0.02) but not crude and cancer-specific survival. Univariately, primary Gleason grade 4 was associated with progression-free survival, as were percent Gleason 4, seminal vesicle invasion, lymph node involvement, pT stage, margin status, DNA ploidy, preoperative PSA, cancer volume and extent of extraprostatic extension. Multivariately, only preoperative PSA (p <0.001), seminal vesicle invasion (<0.001) and DNA ploidy (0.002) were associated with progression-free survival. Primary Gleason grade and percent Gleason 4 were not identified as independently associated with progression-free survival. CONCLUSIONS: In patients with Gleason 7 score prostate cancer primary Gleason grade 3 and 4 cancers are different in pathological parameters and prognosis. However, primary Gleason grade does not provide any additional information than other known prognostic factors, such as preoperative PSA, seminal vesicle invasion and DNA ploidy. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/11586204/Prognostic_factors_for_survival_of_patients_with_pathological_Gleason_score_7_prostate_cancer:_differences_in_outcome_between_primary_Gleason_grades_3_and_4_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)65655-8 DB - PRIME DP - Unbound Medicine ER -