951 PROGNOSTIC VALUE OF PATHOLOGIC GLEASON SCORE AFTER NEOADJUVANT HORMONAL THERAPY FOR PREDICTING SYSTEMIC PROGRESSION FOLLOWING RADICAL PROSTATECTOMY

Abstract

2007, we identified all men with a diagnosis of prostate cancer who received chemotherapy commonly used to treat prostate cancer and androgen suppression therapy (AST) (n 109,794). After eliminating those diagnosed at autopsy, from Louisiana (2005 year), inadequate information about AST or 6 months of AST, prior or subsequent diagnosis of a second primary and with unknown or missing variables, we identified a cohort of 23,618 men. We compared cancer specific survival and overall survival among men who had previously undergone radical prostatectomy, radiation therapy/brachytherapy and neither of these types of therapy for primary tumor. Cox proportional hazard models were used to assess survival. RESULTS: A majority of the patients were 70 years and Caucasian. They had medium or high grade tumors and were diagnosed at stage T1-2. 5% had undergone RP and 93% had received prior radiation while 1.7% received no therapy for primary tumor. About 88% of the patients had a Charlson score of 0-1. Cancer specific survival was significantly worse among men who had neither surgery nor radiation for primary tumor when compared to those who had prior radical prostatectomy (HR 5.313 p 0.0001). There was no difference in cancer specific survival among those who underwent surgery or radiation for their primary tumor. Overall survival was worse among those who received radiation (HR 1.4 p 0.0001) or neither surgery nor radiation (HR 4.06 p 0.0001) compared to those who had surgery. CONCLUSIONS: Prior therapy to the primary prostate cancer in the form of radical prostatectomy or radiation appears to confer a survival advantage in patients who subsequently go on to develop metastatic disease and receive androgen suppressive therapy and chemotherapy. If further validated, this suggests that radical prostatectomy or radiation therapy could be considered even among men found to have incidental regional metastatic disease at the time of surgery or on imaging.