What’s hot today? Tuesday, September 2

Today’s reports address:

  • The potential prognostic significance of a tertiary Gleason pattern in pathologic analysis of prostate cancer stage following a radical prostatectomy
  • The relative safety of two types of external beam radiotherapy in treatment of patients with localized prostate cancer>

Normally, prostate cancer staging is based on a primary and a secondary Gleason pattern. However, the presence of a tertiary Gleason pattern (TGP) in radical prostatectomy (RP) specimens has been associated in some reports with adverse pathology and a higher biochemical recurrence (BCR) rate after RP. Isbarn et al. have investigated the prevalence of a TGP in a contemporary, consecutive, single-center RP series and its association with adverse pathology. Between January and August 2007, 800 eligible patients underwent RP for clinically localized prostate cancer at the authors’ institution.  None of these patients received neoadjuvant hormonal therapy. The presence of the third most prevalent Gleason pattern was documented, regardless of whether it was better or worse than the two predominant Gleason patterns. A TGG was reported in 180 RP specimens (22.5 percent). The presence of a TGP in ≥ 5 percent of the total tumor volume was significantly associated with extracapsular extension (ECE), seminal vesicle involvement (SVI), positive surgical margins (PSM), and lymph node involvement. While noting that their study is limited by the relatively low overall frequency of a TGP, and suggesting the need for additional studies on prognostic impact of a TGP, the authors felt able to confirm the association of the presence of a TGP with adverse pathologic features.

Al-Mamgani et al. have investigated the differences between acute and late gastrointestinal (GI) and genitourinary (GU) toxicities in prostate cancer patients with localized diseasse, treated to a total dose of 78 Gy with either a three-conformal radiotherapy technique with a sequential boost (SEQ) or a simultaneous integrated boost using intensity-modulated radiotherapy (SIB-IMRT). The subjects involved in this study were 78 prostate cancer patients participating in a randomized Dutch trial comparing initial radiotherapy doses of 68 and 78 Gy. They were all treated at the same institution to a total dose of 78 Gy. The median follow-up was 76 and 56 months for the SEQ and SIB-IMRT groups, respectively. The authors report a significantly lower incidence of acute Grade 2 GI toxicity (or higher) in patients treated with SIB-IMRT compared with SEQ (20 vs. 61% percent). For acute GU toxicity and late GI and GU toxicity, the incidence of Grade 2 and higher toxicities was also lower after SIB-IMRT, but these differences were not statistically significant. There were no statistically significant differences in the 5-year freedom from biochemical failure rate (Phoenix definition) (70 percent for SIB-IMRT vs. 61percent for SEQ) or the 5-year freedom from clinical failure rate (90 vs. 72 percent) between the two groups. The authors conclude that, at their institution, SIB-IMRT reduced toxicity compared to SEQ without compromising the outcome in patients with localized prostate cancer treated with radiotherapy to 78 Gy.

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