title: Age, Comorbidity, and the Risk of Prostate Cancer-Specific Mortality in Men With Biopsy Gleason Score 4+3: Implications on Patient Selection for Multiparametric MRI.
abstract: BACKGROUND
  Some men with biopsy Gleason score (GS) 7 prostate cancer (PC) harbor occult GS 8 to 10 PC and might be undertreated with short-term androgen deprivation therapy (ADT) and radiation therapy (RT). With advancing age associated with occult high-grade PC, we evaluated PC-specific mortality (PCSM) risk after RT and short-term ADT for older men with GS 4+3 PC and men of any age with GS 8 to 10 PC.
  
  
  METHODS
  The study cohort comprised 206 men with unfavorable-risk PC treated with RT or RT and 6 months of ADT on a randomized trial between 1995 and 2001. Competing risks regression was used to compare PCSM risk for men with GS 8 to 10 PC to men with GS ≤ 3+4, GS 4+3 and age ≤ 73 years (median age), and GS 4+3 and age > 73 years, adjusting for PC risk factors, comorbidity, and treatment.
  
  
  RESULTS
  After a median follow-up of 14.3 years, 135 men died (65.53%), 24 (17.78%) of PC. Men age > 73 years with GS 4+3 PC did not have significantly lower PCSM risk compared with men with GS 8 to 10 (adjusted hazard ratio [AHR], 1.08; 95% confidence interval [CI], 0.29-4.06; P = .91); whereas unhealthy men (AHR, 0.20; 95% CI, 0.04-0.93; P = .04) and men age ≤ 73 years with GS 4+3 (AHR, 0.09; 95% CI, 0.01-1.03; P = .05) fared better.
  
  
  CONCLUSIONS
  Men age > 73 years with biopsy GS 4+3 did not have a significant difference in PCSM risk than men with GS 8 to 10, supporting further study of multiparametric magnetic resonance imaging in such men with no or minimal comorbidity before determining ADT duration.
authors: Harvard Radiation Oncology Program, Boston, MA. Electronic address: rchandra@lroc.harvard.edu.
authors: Ravi A
authors: RA
authors: Chandra
authors: Department of Statistics, University of Connecticut, Storrs, CT.
authors: Ming-Hui
authors: MH
authors: Chen
authors: Department of Statistics, University of Connecticut, Storrs, CT.
authors: Danjie
authors: D
authors: Zhang
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
authors: Marian
authors: M
authors: Loffredo
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
authors: Anthony V
authors: AV
authors: D'Amico
mesh_terms: D017668:Age of Onset; D000368:Aged; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D018579:Patient Selection; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012044:Regression Analysis; D016896:Treatment Outcome
keywords: Intermediate risk; MRI; Occult cancer; Older age: Prostate cancer