Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 3;4(4):441-446.
doi: 10.21873/cdp.10345. eCollection 2024 Jul-Aug.

Gleason Pattern 5 May Be a Prognostic Factor in Radium-223 Treatment

Mitsuhisa Nishimoto  1 , Kazutoshi Fujita  1 , Aritoshi Ri  2 , Saizo Fujimoto  1 , Yasuo Oguma  2 , Shingo Toyoda  1 , Mamoru Hashimoto  1 , Takashi Kikuchi  1 , Shogo Adomi  1 , Yoshitaka Saito  1 , Yasunori Mori  1 , Takafumi Minami  1 , Masahiro Nozawa  1 , Kazuhiro Yoshimura  1 , Makoto Hosono  2 , Hirotsugu Uemura  1
Affiliations

Gleason Pattern 5 May Be a Prognostic Factor in Radium-223 Treatment

Mitsuhisa Nishimoto et al. Cancer Diagn Progn. .

Abstract

Background/aim: Radium-223 treatment reduces the risk of death in patients with metastatic castration-resistant prostate cancer (CRPC). This study analyzed the prognostic factors in patients treated with radium-223 dichloride.

Patients and methods: Patients who received radium-223 dichloride were retrospectively analyzed. Prostate-specific antigen (PSA) response and alkaline phosphatase (ALP) decline rates were analyzed. Overall survival (OS) was evaluated using Kaplan-Meier curves, and prognostic factors for OS were assessed using Cox proportional hazards analysis.

Results: Fifty-six patients were included in the study. The five-year OS rate in patients after diagnosis of CRPC was 62.2% [95% confidence interval (CI)=27.55-112.45], while the five-year OS rate in patients at the initiation of radium-223 treatment was 21.3% (95%CI=17.20-36.79). Six patients (11.1%) had a >50% PSA decline rate, and 10 (17.9%) had a >50% ALP decline rate. Cox proportional hazards analysis showed that PSA levels at the initiation of radium-223 treatment [hazard ratio (HR)=1.00; 95%CI=1.00-1.00; p=0.0054] and Gleason Pattern (GP) 5 (HR=5.42; 95%CI=1.08-27.27; p=0.0400) were associated with OS. Patients with GP 5 had a significantly poorer prognosis compared with patients with a GP ≤4. Early administration of radium-223 as a first- or second-line treatment was not associated with OS compared with late administration of radium-223 as a third-line or later treatment.

Conclusion: GP 5 and high PSA levels at radium-223 initiation were associated with worse OS. Radium-223 as first- or second-line treatment was not associated with OS. Therefore, a treatment strategy for CRPC based on GP 5 is needed.

Keywords: Gleason pattern; Metastatic castration-resistant prostate cancer; radium-223.

PubMed Disclaimer

Conflict of interest statement

The Authors have no conflicts of interest to declare in relation to this study.

Figures

Figure 1
Figure 1. Cohort dataset.
Figure 2
Figure 2. Overall survival after diagnosis of castration-resistant prostate cancer (A) and from the initiation of radium-223 (B).
Figure 3
Figure 3. Waterfall plots of PSA response rates (A) and ALP decline rates (B).
Figure 4
Figure 4. Overall survival with or without Gleason Pattern 5.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kelly SP, Anderson WF, Rosenberg PS, Cook MB. Past, current, and future incidence rates and burden of metastatic prostate cancer in the United States. Eur Urol Focus. 2018;4(1):121–127. doi: 10.1016/j.euf.2017.10.014. - DOI - PMC - PubMed
    1. Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, Chodacki A, Wiechno P, Logue J, Seke M, Widmark A, Johannessen DC, Hoskin P, Bottomley D, James ND, Solberg A, Syndikus I, Kliment J, Wedel S, Boehmer S, Dall’Oglio M, Franzén L, Coleman R, Vogelzang NJ, O’Bryan-Tear CG, Staudacher K, Garcia-Vargas J, Shan M, Bruland ØS, Sartor O, ALSYMPCA Investigators Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013;369(3):213–223. doi: 10.1056/NEJMoa1213755. - DOI - PubMed
    1. Soloway MS, Hardeman SW, Hickey D, Todd B, Soloway S, Raymond J, Moinuddin M. Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan. Cancer. 1988;61(1):195–202. doi: 10.1002/1097-0142(19880101)61:1<195::aid-cncr2820610133>3.0.co;2-y. - DOI - PubMed
    1. EMA restricts use of prostate cancer medicine XOFIGO. Available at: https://www.ema.europa.eu/en/news/emarestricts-use-prostate-cancer-medic.... [Last accessed on January 14, 2022]
    1. Bauckneht M, Rebuzzi SE, Signori A, Frantellizzi V, Murianni V, Lodi Rizzini E, Mascia M, Lavelli V, Donegani MI, Ponzano M, Gaudiano A, Stazza ML, Licari M, Cavallini L, Laghi V, Cindolo L, Maggi M, Sciarra A, Mammucci P, Sambuceti G, Costa RP, Spanu A, Rubini G, Monari F, De Vincentis G, Fornarini G. The prognostic power of inflammatory indices and clinical factors in metastatic castration-resistant prostate cancer patients treated with radium-223 (BIO-Ra study) Eur J Nucl Med Mol Imaging. 2022;49(3):1063–1074. doi: 10.1007/s00259-021-05550-6. - DOI - PMC - PubMed

LinkOut - more resources