Prognostic value of the Gleason score in prostate cancer

Abstract

Objective To investigate the prognostic value of the Gleason score in prostate cancer. Patients and methods A consecutive series of 305 men with prostate cancer diagnosed at transurethral resection (1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990) and with no curative treatment was analysed. There was no assessment of prostate-specific antigen level during this period. The mean (range) age at diagnosis was 73.7 (52-95) years and the mean follow-up was 6.4 (0-22) years. The influence of Gleason score and the percentage of the specimen area with tumour (% cancer) on diseasespecific survival were assessed using Kaplan-Meier analyses. Results Of 305 cancers, 22% had a Gleason score of 4-5, 29% of 6, 18% of 7 and 32% of 8-10. At the follow-up, 89% of the men had died, of whom 42% had died from prostate cancer. The disease-specific 10-year survival was 56%. The disease-specific mean survival (DSMS) for Gleason score 4-5, 6, 7 and 8-10 was 20, 16, 10 and 5 years, respectively (P<0.001).The DSMS did not differ significantly between Gleason 4 and 5 or between 8-10. There was a trend towards shorter survival for Gleason 4+3=7 (DSMS 9 years) than GS 3+4=7 (DSMS 13 years; P=0.16). Gleason score and % cancer were independent predictors of DSMS (P<0.001). Conclusion The long-term prognosis of prostate cancer on deferred treatment is predicted well by the Gleason score. Four prognostic categories of prostate cancer are suggested, i.e. Gleason score 4-5, 6, 7 and 8-10.

Association between serum levels of insulin‐like growth factor‐1, bioavailable testosterone, and pathologic Gleason score

“…However, the surgical GS is one of the strongest prognostic factors in prostate cancer 37. Recently, an inverse association was reported between serum IGF‐1 and cancer‐specific mortality, but this was not statistically significant ( P trend  = 0.08) 38.…”

Gleason grading and prognostic factors in carcinoma of the prostate

“…A number of clinical end points have been linked to histological grade, including clinical stage, response to different therapies, PSA ('biochemical') failure progression to metastatic disease, and survival, including prostate cancer-specific survival ( Figure 11) and overall survival. 8,[18][19][20]41 Needle biopsy Gleason grade is routinely used to determine eligibility for clinical trials and plan treatment for patients. Men with lower Gleason scores are more likely to elect watching waiting surveillance as initial management.…”

Multiparametric Magnetic Resonance Imaging of Prostate Cancer: Association of Quantitative Magnetic Resonance Parameters with Histopathologic Findings

“…In fact, the grading scheme has now become so vital that it is often used as an integral piece of information for both disease management and treatment stratification in patients with prostate cancer before and after definitive therapy (5,6). Pre-treatment knowledge of the final Gleason grade would be an important advance; however, such information remains elusive (7).…”