title: The prognostic significance of Gleason pattern 5 in prostate cancer patients treated with Pd 103 plus beam radiation therapy.
abstract: BACKGROUND
  There is little clinical information specifically regarding the clinical significance of Gleason pattern 5 in prostate biopsies. Accordingly, we have analyzed the effect of pattern 5 cancer on the prognosis of prostate cancer treated with Pd-103 brachytherapy.
  
  
  METHODS
  Intermediate-risk patients with a Gleason score of 7 or higher and/or a prostate-specific antigen level of 10-20 ng/mL and whose biopsy slides were available for review were treated on a randomized trial. The regimens consisted of implantation with Pd 103 (90 vs 115 Gy [National Institute of Standards and Technology; NIST-1999]), combined with 44 Gy versus 20 Gy of supplemental beam radiation, respectively. Beam radiation was delivered with a four-field arrangement, designed to cover the prostate and seminal vesicles with a 2-cm margin (reduced to 1.0 cm posteriorly). Isotope implantation was per formed by standard techniques, using a modified peripheral loading pattern. All prostate biopsy specimens were reviewed for Gleason score by one investigator (L. T.). Along with assignment of a Gleason score based on established criteria, the presence of any pattern 5 cancer was separately noted and photographed for future review. Freedom from biochemical failure was defined as a serum prostate-specific antigen level < or = 0.5 ng/mL at last follow-up. Four of the 156 patients had insufficient PSA follow-up for inclusion, leaving 152 patients for cancer control analysis.
  
  
  RESULTS
  Overall actuarial biochemical freedom from failure was 86% at 3 years, with 20 patients having experienced biochemical failure. Patients with or without Gleason pattern 5 cancer in their biopsy specimen had similar overall biochemical control. There was no obvious trend toward poorer overall biochemical cancer control in patients with pattern 5 cancer, regardless of whether the pretreatment prostate-specific antigen was less than or greater than 10 ng/mL. Of the 17 patients with biochemical failure, clinically evident bone metastases has developed in five. Three of these five patients who had a positive bone scan had pattern 5 cancer in their biopsy.
  
  
  CONCLUSIONS
  Although the presence of pattern 5 disease may be a risk factor for early systemic failure, we are encouraged that high-dose, brachytherapy-based treatment seems to provide a high likelihood of biochemical cancer control, even in patients with the highest-grade cancer.
authors.affiliation: Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington 98108, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Sherertz
authors.forename: Kent
authors.initials: K
authors.lastname: Wallner
authors.forename: Gregory
authors.initials: G
authors.lastname: Merrick
authors.forename: William
authors.initials: W
authors.lastname: Cavanagh
authors.forename: Wayne
authors.initials: W
authors.lastname: Butler
authors.forename: Daniel
authors.initials: D
authors.lastname: Reed
authors.forename: Lawrence
authors.initials: L
authors.lastname: True
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001706:Biopsy; D001859:Bone Neoplasms / Q000556:secondary; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010165:Palladium / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen