Gleason score and pretreatment prostate-specific antigen in survival among patients with stage D2 prostate cancer

Abstract

Although multiple studies have addressed the prognostic importance of tumor differentiation in patients with clinically localized prostate cancer, few data are available in patients with metastatic disease. We evaluated and compared survival data in two groups of men with Whitmore stage D2 metastatic prostate cancer initially treated with hormonal therapy. A series of 76 patients with D2 metastatic disease were evaluated and treated at the National Cancer Institute (NCI) in conjunction with an additional cohort of 141 patients from the Louisiana State University School of Medicine (LSU). Pathological specimens were classified according to the Gleason score. Fifty-two (25%) of the combined NCI/LSU specimens had a Gleason score of 6 or less, 71 (34%) had a value of 7, and remaining 87 (41%) had scores between 8 and 10. The median PSA at the time of diagnosis for the NCI patients was 294.2 ng/ml. Time to treatment failure was defined as the time that a greater than 50% increase above nadir PSA was noted. In neither group was Gleason score correlated with overall survival. There was no association between the time to progression following hormone therapy and primary tumor Gleason score. The PSA concentration at the time of diagnosis was not correlated with the Gleason score for the NCI patients; however, there was an inverse correlation between pretreatment PSA level and time to progression following hormonal ablation. Gleason score does not appear to impact survival in metastatic prostate cancer. PSA as a marker of the biological behavior in metastatic disease may also be limited. These findings should be reevaluated in larger, better matched cohorts. Novel techniques such as serum proteomics, microarrays, and metastatic cell isolation methods may better predict outcome in advanced prostate cancer.

Impact of initial time to prostate-specific antigen nadir on survival in prostate cancer with bone metastasis initially treated with maximum androgen blockade therapy

“…Association between Gleason score and TTP was also reported in a previous study [19]. On the other hand, the impact of Gleason score on OS is controversial; some reported a positive relationship between them [11] and others negative [12,15,20,21]. The primary PSA level did not affect time to PSA progression nor OS in the present study.…”

“…Some reported a positive association between them [12,14] and others negative [13,15]. However, no correlation has been reported between primary PSA level and OS [11][12][13][14][15][16]. Furthermore, in studies including patients with locally-advanced and metastatic prostate cancer, the primary PSA level did not independently predict TTP nor OS [11,21,23].…”

“…In patients with bone metastatic hormone-sensitive prostate cancer, the association between primary PSA level and TTP was also disputable. Some reported a positive association between them [12,14] and others negative [13,15]. However, no correlation has been reported between primary PSA level and OS [11][12][13][14][15][16].…”

“…In this situation, it is important to precisely evaluate the clinical efficacy of ADT consisting of traditional maximum androgen blockade (MAB) at this time. There have been several reports of outcomes from patients with prostate cancer treated with ADT [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]; however, the number of studies, that reported outcomes in patients with bone metastatic prostate cancer treated primarily with MAB without any local treatment, is limited. Recently, outcomes of MAB as an initial treatment for patients with bone metastatic prostate cancer have been reported, in which the significant impact of PSA kinetics not on OS but on disease progression was demonstrated [16].…”

Effect of IL-18 gene promoter polymorphisms on prostate cancer occurrence and prognosis in Han Chinese population

“…It has been reported that androgen deprivation therapy could retard, suppress, or prevent the carcinogenic progression of prostate cancer in the hormone-dependent growth pattern of most cancer cells. The average progression-free survival time observed in clinical practice is 12-33 months during endocrine therapy (Figg et al, 2004). However, owing to the high heterogeneity and mul- tifocal growth of prostate cancer, the response to endocrine therapy among different patients varies widely.…”