Clinical Characteristics of Gleason Score 10 Prostate Cancer on Core Biopsy without Distant Metastases at Initial Diagnosis
10.3969/j.issn.1674-9081.2016.04.007
- VernacularTitle:初诊无远处转移的穿刺病理Gleason评分10分前列腺癌的临床特点
- Author:
Zhi-Peng MAI
1
;
Wei-Gang YAN
;
Zhi-Gang JI
;
Han-Zhong LI
;
Fu-Quan ZHANG
;
Ke HU
;
Yu XIAO
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院 1 泌尿外科
- Keywords:
prostate cancer;
biopsy pathology;
combined therapy;
treatment effect
- From:
Medical Journal of Peking Union Medical College Hospital
2016;7(4):275-279
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical characteristics of patients with Gleason score 10 prostate cancer on core biopsy and without distant metastases when first diagnosed , and to evaluate the effectiveness of ex-ternal radiotherapy combined with hormone therapy in these patients .Methods From January 2003 to March 2014 , 9 patients were identified as Gleason score 10 prostate cancer without distant metastases when first diag-nosed at Peking Union Medical College Hospital .All the patients were treated by whole pelvic external radiothera-py and long-term hormone therapy .The whole pelvic radiation dose was 50.0 Gy, the boost dose for the whole prostate, bilateral seminal vesicles , and regional positive lymph nodes ranged from 76.2 to 78.0 Gy.The hor-mone therapy used maximal androgen blockade , i.e.oral anti-androgen drugs plus monthly injection of luteini-zing hormone-releasing hormone analogs .We assessed the clinical characteristics of the patients and the treat-ment outcomes of the combination therapy .Survival curves were calculated using the Kaplan-Meier method. Results The median follow-up was 4.8 years ( 26 -75 months ) .The median pre-treatment serum prostate specific antigen ( PSA) level was 11.2 μg/L.The pre-treatment PSA levels were lower than 20 μg/L in 6 pa-tients, and higher than 70 μg/L in 3 patients.The median percentage of positive biopsy cores was 90.9 %. In TNM staging, 3, 4, and 2 cases were classified as T2c, T3a, and T3b, respectively;6 and 3 cases were clas-sified as N0 and N1 , respectively;and all the 9 cases were classified as M0 .Six patients developed biochemical failure, 5 of which progressed into distant metastasis .Four patients died during the follow-up period, 3 of which died of prostate cancer .The 5-year biochemical failure-free survival ( BFFS ) , distant metastasis-free survival ( DMFS ) , cancer-specific survival ( CSS ) , and overall survival ( OS ) were 28.6%, 57.1%, 66.7%, and 57.1%, respectively .Five patients experienced grade 1-2 acute gastrointestinal ( GI) toxicity and 6 patients developed grade 1-2 acute genitourinary (GU) toxicity due to radiotherapy.No late GI or GU toxicity was reported.No bone fracture, cardiovascular event, or other severe hormone therapy-related compli-cations was detected .Conclusions Gleason score 10 prostate cancer without distant metastases when first di-agnosed may be often combined with high risk factors such as high percentage of positive biopsy cores , and ad-vanced tumor stage .Timely and active comprehensive treatments including external radiotherapy and hormone therapy are usually necessary because these patients generally have unfavorable prognosis .
