title: Gleason Score 3 + 5 or 5 + 3 versus 4 + 4 Prostate Cancer: The Risk of Death.
abstract: The International Society of Urological Pathology recommends that Gleason score (GS) 8 prostate cancer (PC) is one prognostic category, yet heterogeneity in cancer control potentially exists amongst men with GS 3+5/5+3 versus GS 4+4 PC. We compared PC-specific mortality (PCSM) and all-cause mortality (ACM) risk among men with GS 3+5/5+3 versus GS 4+4 PC using competing-risks and Cox regression analyses, adjusting for age, known PC prognostic factors, treatment, and a treatment propensity score. Between 1998 and 2012, 462 men with GS 8 PC were treated using brachytherapy with supplemental external-beam radiation therapy and/or androgen deprivation therapy at the Chicago Prostate Cancer Center. After a median follow-up of 7.6 yr, 118 men died, 26 of PC. PCSM (adjusted hazard ratio [AHR] 2.77, 95% confidence interval [CI] 1.13-6.80; p=0.026) and ACM (AHR 1.75, 95% CI 1.06-2.87; p=0.028) were significantly higher for men with GS 3+5/5+3 PC than for men with GS 4+4 PC. Subcategorizing GS 8 into PC with or without grade 5 should be considered as a stratification factor in randomized trials.
  
  
  
  Long-term success rates for men with Gleason score 8 prostate cancer vary depending on whether the most aggressive type of cancer (grade 5) is present at biopsy.
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: mahuynh@lroc.harvard.edu.
authors.forename: Mai Anh
authors.initials: MA
authors.lastname: Huynh
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT, USA.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Wu
authors.affiliation: Chicago Prostate Cancer Center, Westmont, IL, USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Braccioforte
authors.affiliation: Chicago Prostate Cancer Center, Westmont, IL, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital-Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D057216:Propensity Score; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000726:Androgen Antagonists
keywords: Gleason score; Mortality; Prostate cancer