Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results from a Multi-institutional Consortium Study

Abstract

Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis for patients presenting with GS10 PCa are largely unknown due to its rarity. We interrogated a large, multi-institutional consortium of patients with biopsy GS 9-10 disease to identify those with GS 10 PCa and obtain benchmark clinical outcomes data for patients treated with definitive intent. Ninety-eight patients with biopsy GS 10 PCa who received definitive treatment with radical prostatectomy (RP, n = 22), external beam radiotherapy (EBRT, n = 38), and EBRT with a brachytherapy boost (EBRT+BT, n = 38) between 2000 and 2013 were included. Overall survival (OS), cancer-specific survival (CSS), distant metastasis-free survival (DMFS), and biochemical recurrence-free survival (bRFS) were estimated with the Kaplan-Meier method. The median follow-up was 4.9 years. The median age was 67. The T stage distribution was 32 (33%) T1c, 14 (14%) T2a, 13 (13%) T2b, 6 (6%) T2c, 18 (18%) T3a, 5 (5%) T3b, 10 (10%) T4. The median initial prostate-specific antigen was 7.9 (range, 0.4-219). Six patients (27%) who underwent RP received neoadjuvant systemic therapy (mainly androgen deprivation therapy [ADT]), 5% received adjuvant radiotherapy, and 32% received salvage radiotherapy. All patients undergoing EBRT or EBRT+BT received ADT, with median durations of 24 and 22 months, respectively. Systemic salvage therapy rates were 23% among RP patients, 13% among EBRT patients, and 3% among EBRT+BT patients. For the entire cohort, the 5-year and 10-year OS, CSS, DMFS, and bRFS were 77% and 53%, 86% and 69%, 74% and 66%, and 77% and 52%, respectively. Outcomes stratified by treatment type are presented in Table 1. To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Biopsy GS 10 PCas follow a very aggressive natural history with nearly 30% of patients dying of this disease at 10 years. Nonetheless, aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease five years following treatment.Abstract 285; Table 1Outcomes stratified by treatment typeOS (5, 10-yr)CSS (5, 10-yr)DMFS (5, 10-yr)bRFS (5, 10-yr)RP78%, 52%83%, 55%62%, 62%60%, 40%EBRT74%, 54%79%, 70%70%, 55%74%, 48%EBRT-BT80%, 52%93%, 70%84%, 77%88%, 65% Open table in a new tab