Abstract
Simple SummaryWe explored the role of each very high-risk factor and found that simple summation of the number of very high-risk (VHR) factors (T3b–4 and Gleason score 9–10) is an easy and very high predictive power to separate VHR-2 (both T3b–4 and Gleason score 9–10) and others (VHR-1; T3b–4 or Gleason score 9–10, VHR-0; none of T3b–4 and Gleason score 9–10). The VHR-2 group showed a strikingly lower biochemical control rate and distant metastasis free survival rate than other groups, resulting in higher prostate cancer specific mortality than the VHR-1 and VHR-0 groups.This study aimed to examine the role of very high-risk (VHR) factors (T3b–4 and Gleason score 9–10) for prognosis of clinically localized high-risk prostate cancer. We reviewed multi-institutional retrospective data of 1413 patients treated with radiotherapy (558 patients treated with external beam radiotherapy (EBRT) and 855 patients treated with brachytherapy (BT) ± EBRT. We introduced an index by simple summation of the number of VHR factors—VHR-0, VHR-1, and VHR-2. With median follow-up of 69.6 months, the 5-year biochemical disease free survival rate (bDFS), prostate cancer-specific mortality (PCSM), and distant metastasis-free survival (DMSF) rates were 59.4%, 7.65%, and 83.2% for the VHR-2 group, respectively; 86.7%, 1.50%, and 95.4% for the VHR-1 group, respectively; and 93.1%, 0.12%, and 98.2% for the VHR-0 group, respectively. The VHR-2 group had significantly worse bDFS, PCSM, and DMSF than the VHR-0 (hazard ratios: 4.55, 9.607, and 7.904, respectively) and VHR-1 (hazard ratios: 1.723, 2.391, and 1.491, respectively) groups. The VHR-2 group could be identified as a super high-risk group compared with other groups, and could be a good candidate for clinical trials using multimodal intensified treatments. Simple summation of the number of VHR factors is an easy and useful predictive index for bDFS, PCSM, and DMSF.
Highlights
Licensee MDPI, Basel, Switzerland.Risk stratification in newly diagnosed prostate cancer is an important diagnostic process for selecting an optimal management approach for both physicians and patients
To meticulously select patients for adequate treatment, high-risk prostate cancer was subdivided into the very high-risk (VHR) group, considered to have the worst prognosis, including those with primary Gleason score = 5, >4 biopsy cores with a Gleason score of 8–10, or clinical stage
We retrospectively examined the data of patients treated with BT + external beam radiotherapy (EBRT) (822 patients treated with high-dose rate brachytherapy (HDR-BT) boost identified from open data for public use and 33 patients treated with low dose rate brachytherapy (LDR-BT) ± EBRT at Kyoto Prefectural Medical School) [7,8] and EBRT (417 patients treated with EBRT identified from open data and 141 patients treated with intensity modulated radiotherapy [intensity-modulated radiotherapy (IMRT)] at Uji Takeda Hospital) [7,9] (Table 1)
Summary
Risk stratification in newly diagnosed prostate cancer is an important diagnostic process for selecting an optimal management approach for both physicians and patients. The high-risk category was defined as biopsy Gleason score sum ≥ 8, prostatespecific antigen (PSA) level > 20 ng/mL, or clinical stage ≥T3a, which helps identify patients who have a high risk of recurrence and progression after treatment [1]. There is heterogeneity in the high-risk group: the rates of 10-year freedom from biochemical recurrence (bDFS) after surgery ranged from 25 to 68% [2]. To meticulously select patients for adequate treatment, high-risk prostate cancer was subdivided into the very high-risk (VHR) group, considered to have the worst prognosis, including those with primary Gleason score = 5, >4 biopsy cores with a Gleason score of 8–10, or clinical stage
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
