title: The need for more aggressive therapy for men with Gleason 9-10 disease compared to Gleason ≤8 high-risk prostate cancer.
abstract: OBJECTIVE
  To evaluate the outcomes of prostate cancer patients with high-risk disease stratified by Gleason Score (GS) (GS ≤8 vs GS ≥9) treated with external beam radiotherapy (EBRT).
  
  
  METHODS
  The medical records of patients who underwent EBRT between 2003 and 2011 and had nonmetastatic high-risk disease were analyzed retrospectively. Patients were treated with EBRT and all patients received a dose ≥7,560 cGy. Androgen deprivation therapy was given in most patients (90%).
  
  
  RESULTS
  A total of 155 patients were identified (GS ≤8 n = 104, GS ≥9 n = 51), and they had a median presenting prostate-specific antigen (PSA) of 14.7 ng/mL. At a median follow-up of 69 months, the 7-year biochemical failure-free survival was 59.1% in those with GS ≥9 and 69.2% in those with GS ≤8 (p = 0.12). On MVA, Gleason 9-10 (HR 1.83, p = 0.08) was not associated with an increased risk of biochemical recurrence, while a PSA &gt;20 ng/mL (HR 2.39, p = 0.04) was associated with an increased likelihood of biochemical recurrence. Patients with GS ≥9 were noted to have worse 7-year distant metastatic-free survival (79.6% vs 90.5% p = 0.02) and cancer-specific survival (88.5% vs 97.9%, p = 0.006). On MVA, GS ≥9 was a significant indicator of distant metastatic failure and cancer-related death. Seven-year overall survival rates remained similar between the groups.
  
  
  CONCLUSIONS
  In this high-risk cohort, patients with GS 9-10 had significantly worse prostate cancer-related outcomes than other high-risk patients, suggesting that this group may warrant more aggressive treatment modalities than their high-risk counterparts.
authors.affiliation: Department of Veterans Affairs, NY Harbor Campus, Brooklyn, NY - USA.|SUNY Downstate Medical Center, Brooklyn, NY - USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Safdieh
authors.affiliation: Department of Veterans Affairs, NY Harbor Campus, Brooklyn, NY - USA.|SUNY Downstate Medical Center, Brooklyn, NY - USA.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Department of Veterans Affairs, NY Harbor Campus, Brooklyn, NY - USA.|SUNY Downstate Medical Center, Brooklyn, NY - USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Weiner
authors.affiliation: SUNY Downstate Medical Center, Brooklyn, NY - USA.|Kings County Medical Center, Brooklyn, NY - USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nwokedi
authors.affiliation: Department of Veterans Affairs, NY Harbor Campus, Brooklyn, NY - USA.|SUNY Downstate Medical Center, Brooklyn, NY - USA.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007986:Luteinizing Hormone / Q000819:agonists*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000208:ethnology / Q000473:pathology* / Q000628:therapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D007986:Luteinizing Hormone; D017430:Prostate-Specific Antigen