Gleason score predicts androgen independent progression after androgen deprivation therapy.

OBJECTIVE The Gleason system is the most widely utilized histologic grading system for prostate cancer and a powerful predictor of cancer behavior. In this study, we evaluated the prognostic value of the Gleason grading system in predicting progression to androgen independent prostate cancer (AIPC). METHODS Records from 150 patients with advanced or metastatic prostate cancer treated with androgen deprivation therapy (ADT) were retrospectively reviewed. Androgen independent progression was defined as two consecutive elevations of serum prostate specific antigen (PSA) above the nadir value. Kaplan-Meier and the Cox proportional hazards methods were used to assess potential predictors of progression to AIPC. RESULTS Patients with low and moderate Gleason scores experienced significantly longer remissions compared to those with Gleason score of 8-10 (p=0.0006, Log-Rank test). The cumulative hazard of progressing to AIPC increased by almost 70% for each unit increase in total Gleason score. CONCLUSION In this patient cohort the Gleason score was the only independent predictor of progression to AIPC.

[1]  R. Sylvester,et al.  Prostatic Specific Antigen and the Prediction of Prognosis in Metastatic Prostatic Cancer , 1990, Cancer.

[2]  A W Partin,et al.  Is tumor volume an independent predictor of progression following radical prostatectomy? A multivariate analysis of 185 clinical stage B adenocarcinomas of the prostate with 5 years of followup. , 1993, The Journal of urology.

[3]  N. Vogelzang,et al.  Independent Prognostic Factors in Patients With Metastatic (Stage D2) Prostate Cancer , 1991 .

[4]  I. Thompson,et al.  Bilateral orchiectomy with or without flutamide for metastatic prostate cancer. , 1998, The New England journal of medicine.

[5]  J. Hanley,et al.  Competing Risk Analysis of Men Aged 55 to 74 Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer , 1998 .

[6]  P. Goodman,et al.  Leuprolide With and Without Flutamide in Advanced Prostate Cancer , 1990, Cancer.

[7]  A W Partin,et al.  Natural history of progression after PSA elevation following radical prostatectomy. , 1999, JAMA.

[8]  A. Renshaw,et al.  Biochemical Outcome after radical prostatectomy, external beam Radiation Therapy, or interstitial Radiation therapy for clinically localized prostate cancer , 1998 .

[9]  Mc,et al.  Treatment Options for Prostate Cancer: Part 1--Stage, Grade, PSA, and Changes in the 1990's , 1998 .

[10]  J. Miller,et al.  The clinical usefulness of serum prostate specific antigen after hormonal therapy of metastatic prostate cancer. , 1992, The Journal of urology.

[11]  Z. Braf,et al.  Changes in prostate‐specific markers under chronic gonadotrophin‐releasing hormone analogue treatment of stage D prostatic cancer , 1989, Cancer.

[12]  E. Crawford,et al.  Prognostic factors in stage D2 prostate cancer; important implications for future trials: results of a cooperative intergroup study (INT.0036). The National Cancer Institute Intergroup Study #0036. , 1994, Seminars in oncology.

[13]  T. Stamey,et al.  Biological determinants of cancer progression in men with prostate cancer. , 1999, JAMA.

[14]  N. Vogelzang,et al.  Independent prognostic factors in patients with metastatic (stage D2) prostate cancer. The Zoladex Study Group. , 1991, JAMA.

[15]  G. Chodak.  The role of watchful waiting in the management of localized prostate cancer. , 1994, The Journal of urology.

[16]  P. Goodman,et al.  A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. , 1989, The New England journal of medicine.

[17]  A W Partin,et al.  Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. , 1997, JAMA.

[18]  R. Sylvester,et al.  The Importance of Prognostic Factors in the Interpretation of Two EORTC Metastatic Prostate Cancer Trials , 1998, European Urology.

[19]  R. Sylvester,et al.  Maximal Androgen Blockade: Final Analysis of EORTC Phase III Trial 30853 , 1998, European Urology.