Abstract
Men with high‐grade prostate cancer (HGPC) are at greatest risk of disease progression. Clinical risk factors associated with castration‐resistant prostate cancer (CRPC), metastases, and prostate cancer‐specific mortality (PCSM) were identified in a contemporary HGPC cohort. Clinical data was collected from men diagnosed with Gleason sum (GS) ≥8 at the Greater Los Angeles Veterans Affairs (GLA‐VA) Healthcare System between 2000 and 2013. Multivariable competing risks regression analyses assessed progression to CRPC, metastases, and PCSM within three treatment strata. The cumulative incidence of disease progression was calculated at 2, 5, and 10‐year time points. Review of 2149 prostate cancer cases yielded 322 with HGPC. Median survival times for cancer‐specific and overall mortality were significantly shorter in men treated with primary androgen deprivation therapy (ADT) (P = 0.0002 and P < 0.0001). Multivariable analyses revealed that clinical stage N1, GS 10, and treatment with primary ADT were significantly associated with increased risk of CRPC, metastases, and PCSM. Significant differences in these outcomes were not observed in men treated with radical prostatectomy (RP) when compared to those treated with radiation therapy combined with short‐term ADT (XRT‐ADT). Ten‐year event rates of progression to CRPC, metastases, and PCSM, for men treated with primary ADT, were 45.5%, 25.4%, and 25.1%, respectively. In conclusion, GS 10 and lymph node involvement, as well as primary ADT treatment in men with HGPC was associated with increased risk of CRPC, metastases, and PCSM. Curative‐intent treatment with RP or XRT‐ADT is associated with reduced progression rates and death in men with HGPC.
Highlights
To predict the risk of disease recurrence following definitive treatment for localized prostate cancer (PC), risk stratification tools often integrate Gleason sum (GS), prostate specific antigen (PSA), and clinical tumorstage [1,2,3]
Men treated with primary androgen deprivation therapy (ADT) were more likely to be older, Black, and have clinical N1 stage compared to men treated with XRT-A DT and radical prostatectomy (RP) (P < 0.0001, P = 0.0393 and P = 0.0047, respectively)
It is well documented that men with high-grade PC (HGPC) at the time of biopsy or RP have a high risk of biochemical recurrence (BCR) and clinical progression [18]
Summary
To predict the risk of disease recurrence following definitive treatment for localized prostate cancer (PC), risk stratification tools often integrate Gleason sum (GS), prostate specific antigen (PSA), and clinical tumor (cT)stage [1,2,3]. Recent results from the STAMPEDE clinical trial have demonstrated that the addition of docetaxel to standard treatments for high-risk, non metastatic PC is associated with a significantly improved failure-free survival [14]. Given that only a subset of men with BCR experience lethal progression, improved tools are needed to delineate men at highest risk of castration-resistant PC (CRPC), metastases, or death from PC. These tools will help to target men most likely to benefit from combinatorial treatment approaches and prevent unnecessary exposure to adverse effects associated with adjuvant and/or salvage therapies [4, 7, 14, 15]
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