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. 2016 Dec;4(4):152-155.
doi: 10.1016/j.prnil.2016.10.001. Epub 2016 Oct 31.

Impact of Gleason Pattern 5 on outcomes of patients with prostate cancer and iodine-125 prostate brachytherapy

Tomoyuki Makino  1 , Sotaro Miwa  1 , Kiyoshi Koshida  1
Affiliations

Impact of Gleason Pattern 5 on outcomes of patients with prostate cancer and iodine-125 prostate brachytherapy

Tomoyuki Makino et al. Prostate Int. 2016 Dec.

Abstract

Background: The Gleason grading system is a powerful predictor of prostate cancer (PCa) prognosis. Gleason scores (GS) of 8-10 are considered as a single high-risk grade category, and Gleason Pattern 5 (GP5) predicts biochemical recurrence. We report the clinical outcomes of patients treated with 125I prostate brachytherapy for clinically localized PCa and prognosis in the presence or absence of GP5.

Methods: We enrolled 316 patients with T1c-T2N0M0 PCa and undergoing prostate brachytherapy treatment. All patients were followed up for ≥ 1 year. The primary endpoint was biochemical recurrence-free survival. Biochemical recurrence was defined by the Phoenix criteria. Survival curves were calculated by the Kaplan-Meier method, and the prognostic impact of biochemical recurrence was analyzed using a Cox proportional hazards model.

Results: The 5-year biochemical recurrence-free survival rate for all patients was 95.2%, and according to the D'Amico risk classification criteria, the rates were 98.7% for patients in low-risk, 96.9% in intermediate-risk, and 81.1% in high-risk groups (P < 0.0001). The 5-year biochemical recurrence-free survival rates for patients with GS8 or GS9-10 were 87.7% and 61.5%, respectively (P = 0.0057). Multivariate analysis found that GS and clinical T stage were independent predictors of biochemical recurrence.

Conclusions: The presence of GP5 in GS9-10 prostate cancer has a worse prognosis than GS8 prostate cancer in the absence of GP5 for patients undergoing prostate brachytherapy.

Keywords: Brachytherapy; Gleason pattern 5; Iodine-125; Prostate cancer.

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Figures

Fig. 1
Fig. 1
Survival curves calculated by the Kaplan–Meier method. (A) Survival rates for all patients (n = 316). (B) Biochemical recurrence-free survival rates for all patients stratified by the risk group. (C) Biochemical recurrence-free survival rates for all patients stratified by the Gleason score. (D) Biochemical recurrence-free survival rate for high-risk patients with a Gleason score of 8 or 9–10, GS, Gleason scores; OS, overall survival; RFS, recurrence-free survival.
Fig. 2
Fig. 2
Biochemical recurrence-free survival rates for all patients stratified by Gleason grades.
See this image and copyright information in PMC

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