Outcomes in men with Gleason scores of 7

Burdick et al. have carried out a retrospective analysis of data from 705 patients with a pre-treatment biopsy Gleason score of 7 treated at the Cleveland Clinic between 1996 and 2005 to see if there was any difference in the outcomes of patients with a primary Gleason pattern of 3 (i.e., a Gleason score of 3 + 4 = 7) and those with a primary Gleason pattern of 4 (i.e., a Gleason grade of 4 + 3 = 7). Their data included men treated surgically and with different types of radiotherapy.

The results of this study can be summarized as follows:

  • The 705 men included patients treated with radical prostatectomy (n = 310), external beam radiotherapy (n = 268), and brachytherapy (n = 127).
  • The 5-year biochemical relapse-free survival rates (bRFS) were 78 percent and 71 percent for patients with a primary biopsy Gleason pattern of 3 and of 4, respectively. This difference was statistically significant (p = 0.0108).
  • Only for the patients treated with brachytherapy was there a statistically significant, treatment-specific difference in the 5-year bRFS (88 vs. 76 percent, respectively; p = 0.0231).
  • On multivariate analysis, the pre-treatment primary Gleason pattern remained as an independent, statistically significant predictor of bRFS.

Earlier data about the differences in outcome between men with biopsy Gleason sscores of 7 and primary Gleason patterns of 4 as opposed to 3 have tended to be heavily focused on surgical patients. As far as we are aware this is the first large analysis that encompasses men treated with radiotherapy too. The authors draw the conclusion that in such men, primary Gleason pattern 4 carries a worse prognosis for biochemical relapse-free survival than primary Gleason pattern 3, regardless of treatment type.

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