The prognostic significance of Gleason pattern 5 in prostate cancer patients treated with Pd-103 brachytherapy.
OBJECTIVE
To determine the effect of high-grade prostate cancer (Gleason pattern 5) on the prognosis of patients treated with Pd-103 brachytherapy.


METHODS
A total of 499 higher-risk patients [Gleason score 7 or higher or prostate-specific antigen (PSA) 10-20 ng/mL] treated on a prospective protocol with Pd-103 and supplemental external beam radiation were studied. All prostate biopsies were reviewed for Gleason grade by 2 pathologists (L.T. and J.V.). 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 PSA < or = 0.5 ng/mL at last follow-up.


RESULTS
The biochemical control rate at 3 years for all 499 patients was 86%, with 348 patients followed beyond that time. Patients without pattern 5 cancer had an 89% rate of biochemical control at 3 years, versus 72% in the 87 patients with pattern 5 cancer (P = 0.0001). In Cox multivariate regression analysis, which included Gleason score, highest Gleason pattern, and pretreatment PSA, the Gleason score was the single most important predictor of biochemical control (P < 0.0001).


CONCLUSIONS
The presence of pattern 5 disease is a risk factor for biochemical failure. But in sharp contrast to prior studies, Pd-103 brachytherapy-based radiation appears to provide such patients with a high likelihood of cancer eradication.
Mitsuyama
Hiroki
H
Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA 98108-1597, USA.
Wallner
Kent
K
Merrick
Gregory
G
Virgin
Jeffrey
J
Orio
Peter
P
Montgomery
Bruce
B
True
Lawrence D
LD
D001706:Biopsy; D001918:Brachytherapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D017211:Treatment Failure