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Biopsy Gleason pattern 5 tied to recurrence, metastasis, mortality in high-risk prostate cancer

29 Nov 2017

Preoperative biopsy Gleason grade (4 + 4 vs any Gleason pattern 5) subclassification of high-risk prostate cancer identifies men at highest risk for progression, according to a study. Furthermore, any Gleason 5 on biopsy correlates with a higher risk of metastasis, as well as prostate cancer-specific and overall mortality.

The authors assessed men with biopsy Gleason sum 8-10 prostate cancer treated with radical prostatectomy. The patients were divided into those with Gleason 4 + 4 vs those with any pattern 5 (ie, Gleason 3 + 5, 5 + 3, 4 + 5, 5 + 4 or 5 + 5).

Kaplan-Meier, log rank test and Cox proportional hazards models were used to analyse the predictors of biochemical recurrence, metastases, and prostate cancer-specific and overall survival.

A total of 634 men at high risk were identified. Of these, 394 (62 percent) had Gleason 4 + 4 and 240 (38 percent) had Gleason pattern 5 on biopsy. There was no significant difference in baseline characteristics between the groups.

Multivariable analysis revealed that men at high risk with Gleason pattern 5 vs Gleason 4 + 4 had no difference in the risk of biochemical recurrence (hazard ratio [HR], 1.26; 95 percent CI, 0.99 to 1.61; p=0.065). However, patients with any Gleason 5 on biopsy had significantly higher risk for metastasis (HR, 2.55; 1.50 to 4.35; p=0.001), prostate cancer-specific mortality (HR, 2.67; 1.26 to 5.66; p=0.010) and overall mortality (HR, 1.60; 1.09 to 2.34; p=0.016).

“Grouping all Gleason 8-10 tumours together as high-risk lesions may fail to fully stratify men at highest risk for poor outcomes,” according to researchers.

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Most Read Articles
15 Mar 2019
Roche recently announced their targeted therapy combination pertuzumab (Perjeta®)-trastuzumab (Herceptin®) plus conventional chemotherapy for treatment of early breast cancer in those with a subtype known as HER2-positive. The combination was previously used in the metastatic breast cancer setting, where cancer had already spread. There, it was able to prolong cancer sufferers’ lives significantly. Because of its effectiveness, the two-drug combo is new available for treatment of early HER2-positive breast cancer to further reduce the risk of metastasis or cancer recurrence. HER2-positive breast cancers usually spread faster and affect younger women and make up about one quarter of all newly diagnosed breast cancers.