Clinical predictors of survival in men with castration‐resistant prostate cancer

Nakabayashi, Mari; Hayes, Julia H.; Taplin, Mary‐Ellen; Lefèbvre, Patrick; Lafeuille, Marie-Hélène; Pomerantz, Mark; Sweeney, Christopher J.; Duh, Mei Sheng; Kantoff, Philip W.

doi:10.1002/cncr.28102

Cited by 39 publications

(16 citation statements)

References 16 publications

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“…Historically, a diagnosis of Gleason score 6 cancer was not as predictive of good behavior, with a higher rate of progression and some men even dying of PCa [17,19]. In the current study, Gleason score 6 cancer at RP has a 96% cure rate at 5 yr, even including cases with extraprostatic extension and positive margins.…”

Section: Discussionmentioning

confidence: 51%

A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score

et al. 2016

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Background Despite revisions in 2005 and 2014, the Gleason prostate cancer (PCa) grading system still has major deficiencies. Combining of Gleason scores into a three-tiered grouping (6, 7, 8–10) is used most frequently for prognostic and therapeutic purposes. The lowest score, assigned 6, may be misunderstood as a cancer in the middle of the grading scale, and 3 + 4 = 7 and 4 + 3 = 7 are often considered the same prognostic group. Objective To verify that a new grading system accurately produces a smaller number of grades with the most significant prognostic differences, using multi-institutional and multimodal therapy data. Design, setting, and participants Between 2005 and 2014, 20 845 consecutive men were treated by radical prostatectomy at five academic institutions; 5501 men were treated with radiotherapy at two academic institutions. Outcome measurements and statistical analysis Outcome was based on biochemical recurrence (BCR). The log-rank test assessed univariable differences in BCR by Gleason score. Separate univariable and multivariable Cox proportional hazards used four possible categorizations of Gleason scores. Results and limitations In the surgery cohort, we found large differences in recurrence rates between both Gleason 3 + 4 versus 4 + 3 and Gleason 8 versus 9. The hazard ratios relative to Gleason score 6 were 1.9, 5.1, 8.0, and 11.7 for Gleason scores 3 + 4, 4 + 3, 8, and 9–10, respectively. These differences were attenuated in the radiotherapy cohort as a whole due to increased adjuvant or neoadjuvant hormones for patients with high-grade disease but were clearly seen in patients undergoing radiotherapy only. A five–grade group system had the highest prognostic discrimination for all cohorts on both univariable and multivariable analysis. The major limitation was the unavoidable use of prostate-specific antigen BCR as an end point as opposed to cancer-related death. Conclusions The new PCa grading system has these benefits: more accurate grade stratification than current systems, simplified grading system of five grades, and lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa. Patient summary We looked at outcomes for prostate cancer (PCa) treated with radical prostatectomy or radiation therapy and validated a new grading system with more accurate grade stratification than current systems, including a simplified grading system of five grades and a lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa.

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Section: Discussionmentioning

confidence: 51%

A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score

et al. 2016

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“…Поиск факторов прогноза показал значимое вли-яние на ОВ таких факторов, как наличие болевого синдрома, статус по шкале ECOG 2, уровень ПСА ≥ 288 нг/мл, ЛДГ ≥ 450 Ед/л, ЩФ ≥ 250 Ед/л, кальция < 2,28 ммоль/л и гемоглобина < 11,5 г/дл, а также дли-тельность ответа на ГТ < 24 мес. Полученные резуль-таты коррелируют с данными других исследований [8][9][10][11][12]. Следует заметить, что такой параметр, как на-личие висцеральных метастазов, не включенный в многофакторный анализ ввиду малого числа таких пациентов на момент начала лечения мКРРПЖ, без-условно также является значимым с клинической точки зрения.…”

Section: Discussionunclassified

Predictors of overall survival in patients with metastatic castration-resistant prostate cancer

Маркова¹,

Поликарпова²,

Камолов³

et al. 2015

Onkourologiya

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“…46,47 Historically, a diagnosis of Gleason score 6 cancer was not as predictive of good behavior, with a higher rate of progression and some men even dying of prostate cancer. 47,48 Currently, it is recommended that all cribriform glands be considered as Gleason pattern 4. Ill-defined glands with poorly formed glandular lumina were not discussed or depicted by Gleason as either Gleason pattern 3 or 4.…”

Section: Updated International Society Of Urologic Pathology Grading mentioning

confidence: 99%

Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

Tosoian¹,

Loeb²,

Epstein³

et al. 2016

American Society of Clinical Oncology Educational Book

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Active surveillance (AS) has emerged as a standard management option for men with very low-risk and low-risk prostate cancer, and contemporary data indicate that use of AS is increasing in the United States and abroad. In the favorable-risk population, reports from multiple prospective cohorts indicate a less than 1% likelihood of metastatic disease and prostate cancer-specific mortality over intermediate-term follow-up (median 5 to 6 years). Higher-risk men participating in AS appear to be at increased risk of adverse outcomes, but these populations have not been adequately studied to this point. Although monitoring on AS largely relies on serial prostate biopsy, a procedure associated with significant morbidity, there is a need for improved diagnostic tools for patient selection and monitoring. Revisions from the 2014 International Society of Urologic Pathology consensus conference have yielded a more intuitive reporting system and detailed reporting of low-intermediate grade tumors, which should facilitate the practice of AS. Meanwhile, emerging modalities such as multiparametric magnetic resonance imaging and tissue-based molecular testing have shown prognostic value in some populations. At this time, however, these instruments have not been sufficiently studied to consider their routine, standardized use in the AS setting. Future studies should seek to identify those platforms most informative in the AS population and propose a strategy by which promising diagnostic tools can be safely and efficiently incorporated into clinical practice.

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Clinical predictors of survival in men with castration‐resistant prostate cancer

Cited by 39 publications

References 16 publications

A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score

A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score

Predictors of overall survival in patients with metastatic castration-resistant prostate cancer

Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

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