title: Primary Gleason pattern does not impact survival after permanent interstitial brachytherapy for Gleason score 7 prostate cancer.
abstract: BACKGROUND
  The impact of primary Gleason pattern was determined on cause-specific (CSS), biochemical progression-free (bPFS), and overall survival (OS) after brachytherapy for Gleason score 7 prostate cancer.
  
  
  METHODS
  From April 1995 to October 2003, 530 patients underwent brachytherapy for Gleason score 3+4 (n = 300) or Gleason 4+3 (n = 230) prostate cancer. All patients underwent brachytherapy more than 3 years before analysis. The median follow-up was 5.7 years. Of the 530 patients, 412 (77.7%) received supplemental external beam radiation therapy (XRT) and 177 (33.4%) received androgen deprivation therapy. bPFS was defined by a prostate-specific antigen (PSA) </=0.40 ng/mL after nadir. Multiple parameters were evaluated as predictors of CSS, bPFS, and OS.
  
  
  RESULTS
  At 10 years, Gleason 3+4 versus 4+3 did not predict for CSS (96.7% vs 93.3%, P = .506), bPFS (97.0% vs 92.9%, P = .085), or OS (77.0% vs 78.0%, P = .933). Cox linear regression analysis demonstrated that clinical stage and radiation dose (D90) predicted for CSS, whereas pretreatment PSA, clinical stage, and prostate size predicted for bPFS. Patient age, diabetes, and tobacco were the strongest predictors for OS. To date, 57 patients have died, with 80.7% due to cardiovascular/pulmonary events or secondary malignancies. Five patients have died of prostate cancer.
  
  
  CONCLUSIONS
  The primary Gleason pattern did not impact CSS, bPFS, or OS in Gleason score 7 prostate cancer. Deaths from cardiovascular/pulmonary disease and second malignancies were 9.6 times more common than death from prostate cancer.
authors.affiliation: Schiffler Cancer Center, Wheeling, West Virginia 26003-6300, USA. gmerrick@urologicresearchinstitute.org
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Merrick
authors.forename: Robert W
authors.initials: RW
authors.lastname: Galbreath
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Butler
authors.forename: Kent E
authors.initials: KE
authors.lastname: Waller
authors.forename: Zachariah A
authors.initials: ZA
authors.lastname: Allen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lief
authors.forename: Edward
authors.initials: E
authors.lastname: Adamovich
mesh_terms: D000368:Aged; D001918:Brachytherapy; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D016019:Survival Analysis