James Byunghoon Yu MD, Presenter: Nothing to Disclose

Primary Gleason score has been identified as an important prognostic factor in patients with prostate cancer. In patients with Gleason 7 prostate cancer, patients with a primary score of 4 have a worse prognosis compared to a primary score of 3. Data regarding patients with overall Gleason 9 prostate cancer is limited given the small proportion of patients with Gleason 9 prostate cancer. The prognostic value of the Gleason score has been shown to depend on the expertise of the reviewing pathologist.

The Yale prostate cancer database was analyzed for patients with Gleason 9 prostate cancer and PSA < 10. The date of biochemical failure was defined as the date of the first PSA value equal to or greater than the PSA nadir + 2. All patients received primary external beam irradiation and received at least 75 Gy total prostate dose. All patients had adjuvant hormonal therapy. Kaplan-Meier survival curves were constructed and compared using the log-rank test.

20 patients were identified with Gleason 9 prostate cancer, treated from 2000-2007. Median age of diagnosis was 70 (range 56 - 81). 17 patients were white and 3 were African-American. 13 patients had a primary Gleason score of 4, and 7 patients had a primary Gleason score of 5. 10 patients received whole pelvic radiation in addition to prostate radiation. A primary Gleason pattern of 5 had a significantly worse biochemical disease free survival (BDFS) (p = 0.0013) compared to a primary Gleason pattern of 4. Median BDFS for Gleason 5+4 prostate cancer was 1.8 years vs. 3.2 years for Gleason 4+5 prostate cancer.

In patients with prostate cancer of total Gleason score 9 and a PSA < 10, who have been treated with prostate IMRT, a primary Gleason score of 5 is associated with a worse prognosis than a primary Gleason score of 4. This study is retrospective and of small number, but indicates that even with a high total Gleason score, the primary Gleason pattern still has prognostic significance when reviewed at an academic center.

Yu, J, For Patients with Gleason Score 9 Prostate Cancer: A Primary Gleason Pattern of 5 Indicates a Worse Prognosis than a Primary Gleason Pattern of 4.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/7000330.html