- Email: [email protected]
The prognostic significance of the worst vs. overall gleason score in patients with multiple positive prostate needle biopsies
206
I . J . Radiation Oncology • Biology • Physics
DMF OS
188
Volume 48, Number 3, Supplement, 2000
RT alone (n - 247) GSC 3 + 4
RT alone (n = 247) GSC 4 + 3
RT alone (n = 247) Significance
RT + H (n - 260) GSC 3 + 4
RT + H (n = 260) GSC 4 + 3
RT + H (n = 260) Significance
26% 74%
37% 68%
0.07 0.38
19% 78%
20% 77%
0.89 0.80
The prognostic significance of the worst vs. overall gleason score in patients with multiple positive prostate needle biopsies
J. D. Forman, C. DeYnung, S. Tekyi-Mensah, S. Bolton, D. Grignon
Wayne State University, Karmanos Cancer Institute, Detroit, MI
Purpose: This study was designed to determine the prognostic significance of using the worst vs. the overall Gleason Score in patients treated with external beam irradiation.
Materials & Methods: The charts of 698 patients with localized adenocarcinoma of the prostate treated on IRB approved dose escalation protocols between January 1992 and December 1998 were reviewed. Only patients with sextant biopsies reviewed by a pathologist at W a y n e State University (WSU) were included. A single pathologist (DG) reviewed the pathology and assigned a worst as well as overall Gleason score for each patient. The biochemical disease free survival (bDFS) of the overall vs worst Gleason scores were compared.
Results: In total, 255 patients met the entrance criteria and were included in this study. Seventy-three patients had one positive biopsy and 182 patients had multiple ( > 2 ) positive biopsies. Of patients with multiple positive biopsies, 75 had the same Gleason score in all biopsies, thus there were 107 patients with sextant biopsies, with multiple positive biopsies in which the Gleason score varied among the positive cores. Twenty-five patients (23%) failed during the follow-up period (median 3 years). Using the worst Gleason score (WGS) the absolute number of failures were: 9% (1/11) for a WGS -<6, 20% (12/59) for a WGS - 7 and 33% (12/36) for a WGS ->8. Using the overall Gleason score (OGS), these numbers were: 9% (1/11), 22% (18/83) and 50% (6/12), respectively. The 3-year actuarial bDFS were 89, 59 and 52% for the WGS -<6, 7 and 8 - 1 0 respectively. These rates were 89, 63% and 0%, respectively for the OGS. Conclusions: In patients with multiple positive prostate biopsies, the predictive value of the overall Gleason score was significantly better than using the single worst core for predicting disease free survival. This has important implications in identifying patients who may benefit from either neo-adjuvant or adjuvant hormal therapy.
I 89
Validating a treatment policy for PSA failures following 3D-conformal radiation therapy
W. H. Pinover, A. L. Hanlon, E. M. Horwitz, P. R. Anderson, G. E. Hanks
Fox Chase Cancer Center, Philadelphia, PA
Purpose: To present an outcomes validation for the Fox Chase Cancer Center (FCCC) management policy of prostate specific antigen (PSA) failures following 3D-conformal radiation therapy (3DCRT).
Methods: Eligible patients included 246 men with TI-4NOM0 prostate cancer who demonstrated PSA failure (ASTRO definition) after completing definitive 3DCRT alone or with androgen deprivation (AD) between 5/89 and i1/97. Three non-responders were excluded. Patients were evaluated for freedom from distant metastasis (FDM), cause-specific survival (CSS) and overall survival (OS). Variables evaluated in the multivariate analysis (MVA) included initial PSA, Gleason score, T stage, dose, PSA nadir, time-to-PSA failure, PSA doubling time (PSADT), initial AD use, and A D use upon PSA failure. Since 1989, PSA failure only patients at FCCC have been observed or treated with A D depending upon the PSA doubling time (PSADT). It has been our general policy to recommend A D in men demonstrating PSA failure with a rapid PSADT (--<12 months) and observation in those with a slower PSADT. Outcome (FDM) according to compliance with the FCCC management policy was evaluated. The median follow-up is 46 months.
Results: Of the 246 men demonstrating PSA failure, 59% were T1/T2A, 61% were Gleason score 2-6, and pretreatment PSA < 10, 1 0 - l 9.9, and -->20 was seen in 32%, 28% and 40%, respectively. Twenty-seven percent received initial AD along with 3DCRT. The 5-year FDM, CSS, and OS rates for the entire group were 76%, 92% and 76%, respectively. No variables were predictive of CSS or OS. Four variables found to be independent predictors of FDM were Gleason score (p - .0039), PSA nadir (p = .0001), PSADT (p = .0001), and the use of AD upon PSA failure (p = .0001). Table 1 illustrates the 5-year FDM outcome according to compliance with the FCCC policy for the short and long PSADT groups. There was no outcome difference for the group with PSADT > 1 2 months being observed or receiving AD upon PSA failure (5-year FDM 92% vs. 88%; p - .74) and compliance was excellent (89%). There was a difference for the -< 12-month PSADT patients who were observed, compared to the AD upon PSA failure group (5-year FDM 57% vs. 78%; p - .003) and compliance in this group was poor (40%). In the PSADT -<12-month group, the median time-to-distant failure was significantly longer in men treated with AD upon PSA failure (6 months vs. 25 months; p = .02). Of the 89 men with PSADT > 1 2 months being observed, only 4 have been placed on AD for distant failure.
Conclusion: Our results validate the use of PSADT as an indicator of who can be observed expectantly or treated with A D for PSA failure following 3DCRT. Prospective trials are needed to further define the optimal treatment for these patients. % 5-year freedom from distant metastasis Treatment
P S A D T > 12 m (No.)
P S A D T < 12 m (No.)
Observation AD upon PSA failure
92% (89) 88% (11) p .74
57% (87) 78% (59) p .003
I . J . Radiation Oncology • Biology • Physics
DMF OS
188
Volume 48, Number 3, Supplement, 2000
RT alone (n - 247) GSC 3 + 4
RT alone (n = 247) GSC 4 + 3
RT alone (n = 247) Significance
RT + H (n - 260) GSC 3 + 4
RT + H (n = 260) GSC 4 + 3
RT + H (n = 260) Significance
26% 74%
37% 68%
0.07 0.38
19% 78%
20% 77%
0.89 0.80
The prognostic significance of the worst vs. overall gleason score in patients with multiple positive prostate needle biopsies
J. D. Forman, C. DeYnung, S. Tekyi-Mensah, S. Bolton, D. Grignon
Wayne State University, Karmanos Cancer Institute, Detroit, MI
Purpose: This study was designed to determine the prognostic significance of using the worst vs. the overall Gleason Score in patients treated with external beam irradiation.
Materials & Methods: The charts of 698 patients with localized adenocarcinoma of the prostate treated on IRB approved dose escalation protocols between January 1992 and December 1998 were reviewed. Only patients with sextant biopsies reviewed by a pathologist at W a y n e State University (WSU) were included. A single pathologist (DG) reviewed the pathology and assigned a worst as well as overall Gleason score for each patient. The biochemical disease free survival (bDFS) of the overall vs worst Gleason scores were compared.
Results: In total, 255 patients met the entrance criteria and were included in this study. Seventy-three patients had one positive biopsy and 182 patients had multiple ( > 2 ) positive biopsies. Of patients with multiple positive biopsies, 75 had the same Gleason score in all biopsies, thus there were 107 patients with sextant biopsies, with multiple positive biopsies in which the Gleason score varied among the positive cores. Twenty-five patients (23%) failed during the follow-up period (median 3 years). Using the worst Gleason score (WGS) the absolute number of failures were: 9% (1/11) for a WGS -<6, 20% (12/59) for a WGS - 7 and 33% (12/36) for a WGS ->8. Using the overall Gleason score (OGS), these numbers were: 9% (1/11), 22% (18/83) and 50% (6/12), respectively. The 3-year actuarial bDFS were 89, 59 and 52% for the WGS -<6, 7 and 8 - 1 0 respectively. These rates were 89, 63% and 0%, respectively for the OGS. Conclusions: In patients with multiple positive prostate biopsies, the predictive value of the overall Gleason score was significantly better than using the single worst core for predicting disease free survival. This has important implications in identifying patients who may benefit from either neo-adjuvant or adjuvant hormal therapy.
I 89
Validating a treatment policy for PSA failures following 3D-conformal radiation therapy
W. H. Pinover, A. L. Hanlon, E. M. Horwitz, P. R. Anderson, G. E. Hanks
Fox Chase Cancer Center, Philadelphia, PA
Purpose: To present an outcomes validation for the Fox Chase Cancer Center (FCCC) management policy of prostate specific antigen (PSA) failures following 3D-conformal radiation therapy (3DCRT).
Methods: Eligible patients included 246 men with TI-4NOM0 prostate cancer who demonstrated PSA failure (ASTRO definition) after completing definitive 3DCRT alone or with androgen deprivation (AD) between 5/89 and i1/97. Three non-responders were excluded. Patients were evaluated for freedom from distant metastasis (FDM), cause-specific survival (CSS) and overall survival (OS). Variables evaluated in the multivariate analysis (MVA) included initial PSA, Gleason score, T stage, dose, PSA nadir, time-to-PSA failure, PSA doubling time (PSADT), initial AD use, and A D use upon PSA failure. Since 1989, PSA failure only patients at FCCC have been observed or treated with A D depending upon the PSA doubling time (PSADT). It has been our general policy to recommend A D in men demonstrating PSA failure with a rapid PSADT (--<12 months) and observation in those with a slower PSADT. Outcome (FDM) according to compliance with the FCCC management policy was evaluated. The median follow-up is 46 months.
Results: Of the 246 men demonstrating PSA failure, 59% were T1/T2A, 61% were Gleason score 2-6, and pretreatment PSA < 10, 1 0 - l 9.9, and -->20 was seen in 32%, 28% and 40%, respectively. Twenty-seven percent received initial AD along with 3DCRT. The 5-year FDM, CSS, and OS rates for the entire group were 76%, 92% and 76%, respectively. No variables were predictive of CSS or OS. Four variables found to be independent predictors of FDM were Gleason score (p - .0039), PSA nadir (p = .0001), PSADT (p = .0001), and the use of AD upon PSA failure (p = .0001). Table 1 illustrates the 5-year FDM outcome according to compliance with the FCCC policy for the short and long PSADT groups. There was no outcome difference for the group with PSADT > 1 2 months being observed or receiving AD upon PSA failure (5-year FDM 92% vs. 88%; p - .74) and compliance was excellent (89%). There was a difference for the -< 12-month PSADT patients who were observed, compared to the AD upon PSA failure group (5-year FDM 57% vs. 78%; p - .003) and compliance in this group was poor (40%). In the PSADT -<12-month group, the median time-to-distant failure was significantly longer in men treated with AD upon PSA failure (6 months vs. 25 months; p = .02). Of the 89 men with PSADT > 1 2 months being observed, only 4 have been placed on AD for distant failure.
Conclusion: Our results validate the use of PSADT as an indicator of who can be observed expectantly or treated with A D for PSA failure following 3DCRT. Prospective trials are needed to further define the optimal treatment for these patients. % 5-year freedom from distant metastasis Treatment
P S A D T > 12 m (No.)
P S A D T < 12 m (No.)
Observation AD upon PSA failure
92% (89) 88% (11) p .74
57% (87) 78% (59) p .003