Age, Comorbidity, and the Risk of Prostate Cancer-Specific Mortality in Men With Biopsy Gleason Score 4+3: Implications on Patient Selection for Multiparametric MRI

Purpose We investigated whether pretreatment factors predicted time to prostate cancer–specific mortality (PCSM) after conventional-dose and conformal radiation therapy (CRT). Patients and Methods Between 1988 and 2002, 421 patients with low (prostate-specific antigen [PSA] level ≤ 10 ng/mL and biopsy Gleason score ≤ 6) or favorable intermediate-risk (PSA > 10 to 15 ng/mL or biopsy Gleason score 3 + 4, but not both factors) disease underwent CRT (median dose, 70.4 Gy). Cox regression multivariable analysis was performed to determine whether the PSA level, Gleason score, T category, or the percentage of positive cores (% PC) predicted time to PCSM after CRT. After a median follow-up of 4.5 years, 117 (28%) patients have died. Results The % PC was the only significant predictor (Cox P ≤ .03). The relative risk of PCSM after CRT for patients with ≥ 50% as compared with less than 50% PC was 10.4 (95% CI, 1.2 to 87; Cox P = .03), 6.1 (95% CI, 1.3 to 28.6; Cox P = .02), and 12.5 (95% CI, 1.5 to 107; Cox P = .02) in men with a PSA ≤ 10 and Gleason score ≤ 6, PSA ≤ 10 and Gleason score ≤ 7, and PSA ≤ 15 and Gleason score ≤ 6, respectively. By 5 years after CRT, 5% to 9% compared with less than 1% (log-rank P ≤ .01) of these patients experienced PCSM if they had ≥ 50% compared with less than 50% PC, respectively. Conclusion CRT dose-escalation techniques, the addition of hormonal therapy, or both should be considered in the management of patients with low or favorable intermediate-risk disease and ≥ 50% PC.

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Predictors of Prostate Cancer–Specific Mortality After Radical Prostatectomy or Radiation Therapy

Journal of Clinical Oncology ◽

10.1200/jco.2005.01.2906 ◽

2005 ◽

Vol 23 (28) ◽

pp. 6992-6998 ◽

Cited By ~ 145

Author(s):

Ping Zhou ◽

Ming-Hui Chen ◽

David McLeod ◽

Peter R. Carroll ◽

Judd W. Moul ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Study Cohort ◽

Psa Failure ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Biopsy Gleason Score

Purpose We evaluated predictors of prostate cancer–specific mortality (PCSM) after prostate-specific antigen (PSA) failure after radical prostatectomy (RP) or radiation therapy (RT). Patients and Methods A total of 1,159 men with clinically localized prostate cancer treated with RP (n = 498) or RT (n = 661) developed PSA failure, and they formed the study cohort. Competing risk regression analyses were used to evaluate whether previously identified predictors of time to metastasis, including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure, could also predict time to PCSM after PSA failure. The cumulative incidence method was used to estimate PCSM after PSA failure. Results A post-RP PSA-DT of less than 3 months (hazard ratio [HR], 54.9; 95% CI, 16.7 to 180), a post-RT PSA-DT of less than 3 months (HR, 12.8; 95% CI, 7.0 to 23.1), and a biopsy Gleason score of 8 to 10 (HR, 6.1; 95% CI, 3.4 to 10.7) for patients treated with RT were significantly associated with PCSM. Post-RP estimated rates of PCSM 5 years after PSA failure were 31% (95% CI, 17% to 45%) v 1% (95% CI, 0% to 2%) for patients with PSA-DT of less than 3 months v ≥ 3 months. Post-RT estimated rates of PCSM 5 years after PSA failure were 75% (95% CI, 59% to 92%) v 35% (95% CI, 24% to 47%) for patients with a biopsy Gleason score of ≥ 8 v ≤ 7, respectively, and PSA-DT of less than 3 months; these rates were 15% (95% CI, 0.8% to 28%) v 4% (95% CI, 1% to 6%), respectively, for patients with a PSA-DT ≥ 3 months. Conclusion Patients at high risk for PCSM after PSA failure can be identified based on post-RP PSA-DT or post-RT PSA-DT and biopsy Gleason score. These parameters may be useful in identifying patients for a randomized trial evaluating hormonal therapy with or without docetaxel.

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Optimizing patient selection for dose escalation techniques using the prostate-specific antigen level, biopsy gleason score, and clinical T-stage

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(99)00303-x ◽

1999 ◽

Vol 45 (5) ◽

pp. 1227-1233 ◽

Cited By ~ 16

Author(s):

Anthony V D’Amico ◽

Richard Whittington ◽

S.Bruce Malkowicz ◽

Delray Schultz ◽

Andrew A Renshaw ◽

...

Keyword(s):

Prostate Specific Antigen ◽

Gleason Score ◽

Patient Selection ◽

Dose Escalation ◽

Specific Antigen ◽

Prostate Specific Antigen Level ◽

Antigen Level ◽

T Stage ◽

Selection For ◽

Biopsy Gleason Score

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Aspirin use and mortality in men with localised prostate cancer: A cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5084 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5084-5084

Author(s):

Evelyn M Flahavan ◽

Kathleen Bennett ◽

Linda Sharp ◽

Thomas Ian Barron

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Smoking Status ◽

Tumour Size ◽

Cox Proportional Hazards ◽

Stage I ◽

Specific Mortality ◽

Prescription Refill ◽

Cancer Specific Mortality ◽

Cox 2

5084 Background: Cyclooxygenase-2 (COX-2) expression in prostate cancer has been associated with high grade tumours and poorer prognosis. Use of aspirin, a COX-2 inhibitor, has been associated with reduced prostate cancer mortality in some studies. These studies have not, however, provided information on the dose and timing of aspirin use. Methods: National Cancer Registry Ireland data was used to identify men with stage I-III prostate cancer (ICD10 C61) diagnosed 2001-2006. Aspirin use in the year preceding prostate cancer diagnosis was identified from linked prescription refill data (General Medical Services) and stratified by dose (low ≤75mg, high >75mg) and dosing intensity (proportion of days in that year with aspirin supply available). Cox proportional hazards models, adjusted for age, smoking status, year of incidence, comorbidity score, Gleason score, tumour size, pre-diagnostic statin use, and receipt of radiation (time varying) were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between aspirin use and all-cause and prostate cancer-specific mortality. Interactions with tumour characteristics were examined. Results: 2,936 men with stage I-III prostate cancer were identified (aspirin users, N=1,131; 38.5%). Median patient follow-up was 5.5 years. In multivariate analyses, aspirin use was not associated with a significant reduction in prostate cancer-specific (HR 0.90, 95% CI 0.68-1.20) or all-cause mortality (HR 0.98, 95% CI 0.84-1.15). In dose response analyses aspirin use was associated with a significantly lower risk of prostate cancer-specific mortality in men receiving >75mg of aspirin (HR 0.59, 95% CI 0.35-1.00, p=0.048) but not ≤75mg aspirin (HR 1.01, 95% CI 0.75-1.37, p=0.938). Stronger associations were also observed in men with higher aspirin dosing intensity or a Gleason score >7. Conclusions: Pre-diagnostic aspirin use, measured using objective prescription refill data, was associated with a significant reduction in prostate cancer-specific mortality in men with stage I-III prostate cancer receiving >75mg of aspirin. These results confirm previous findings, and provide important new information regarding the dose of aspirin associated with survival benefit.

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