title: Clinical predictors of survival in men with castration-resistant prostate cancer: evidence that Gleason score 6 cancer can evolve to lethal disease.
abstract: BACKGROUND
  This study sought to characterize Modern patients with castration-resistant prostate cancer (CRPC) and identify pretreatment clinical predictors of survival.
  
  
  METHODS
  A cohort of men with CRPC with and without metastases (M) treated with secondary hormonal therapy (2eHT) and/or chemotherapy (CT) was identified from the authors' institutional database. Associations of patient and disease characteristics at diagnosis, at androgen-deprivation therapy (ADT) initiation, at CRPC index date, and survival were evaluated. CRPC index date was defined as the start date of either 2eHT or CT, whichever came first.
  
  
  RESULTS
  In the cohort of 622 men, 434 men (70%) had M-positive disease; 552 men (89%) received 2eHT and 70 men (11%) received CT as their initial CRPC treatment. There were 410 deaths (66%) at the time of analysis. Median overall survival (OS) was 35 months (quartile 1, quartile 3: 21 months, 61 months). In multivariate analyses, higher biopsy Gleason score, the presence of M at ADT initiation, shorter time from ADT start to CRPC, higher prostate-specific antigen and poorer Eastern Cooperative Oncology Group performance status at CRPC and M at CRPC were predictive of shorter OS. Interestingly, whereas some men with biopsy Gleason scores of 6 died of their disease (N = 42), they had a longer OS after CRPC compared with those with a Gleason score ≥ 7.
  
  
  CONCLUSIONS
  This large retrospective study of patients with CRPC in a tertiary cancer center shows that biopsy Gleason score of 6 is associated with a less aggressive CRPC course, and the impact that M at ADT initiation and CRPC have on outcome is quantified.
authors.affiliation: Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Mari
authors.initials: M
authors.lastname: Nakabayashi
authors.forename: Julia
authors.initials: J
authors.lastname: Hayes
authors.forename: Mary-Ellen
authors.initials: ME
authors.lastname: Taplin
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.forename: Marie-Helene
authors.initials: MH
authors.lastname: Lafeuille
authors.forename: Mark
authors.initials: M
authors.lastname: Pomerantz
authors.forename: Christopher
authors.initials: C
authors.lastname: Sweeney
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
authors.forename: Philip W
authors.initials: PW
authors.lastname: Kantoff
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000032:analysis; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis
chemical_list: D017430:Prostate-Specific Antigen
keywords: biopsy Gleason score; castration-resistant prostate cancer; clinical predictors; overall survival; prostate-specific antigen