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Original article
peer-reviewed

Risk of Death from Prostate Cancer with and without Definitive Local Therapy when Gleason Pattern 5 is Present: A Surveillance, Epidemiology, and End Results Analysis



Abstract

Purpose

The purpose is to evaluate the patterns of care and comparative effectiveness for cause-specific and overall survival of definitive local treatments versus conservatively managed men with a primary or secondary Gleason pattern of 5.

Methods and materials

Patients diagnosed from 2004 to 2012 with a primary or secondary Gleason pattern of 5 N0M0 prostate cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier and Cox regression analyses were used to estimate the survival.

Results

We identified 20,560 men. Median age and follow-up were 68 years and 4.33 years, respectively. At eight years, cause-specific survival (CSS) was 86.6% and 57.4% of those receiving and not receiving definitive local treatments, respectively. For CSS multivariate analysis, the following were significant: age, race, insurance status, total Gleason Score, T-stage, and type or omission of definitive local treatments. Compared to prostatectomy alone, men not undergoing definitive local treatments had the highest risk of death (HR: 6.07; 95% CI: 5.19-7.10). Those undergoing external beam radiotherapy alone (HR: 2.11; 95% CI: 1.80-2.48) were also at elevated risk of death. The number needed to treat (NNT) to prevent a prostate cancer death at eight years was three persons.

Conclusions

Death from prostate cancer with a primary or secondary Gleason pattern of 5 histology without definitive local treatment is high. In this hypothesis-generating study, we found that men with a limited life expectancy (less than eight years) and non-metastatic Gleason pattern of 5 disease may benefit from definitive local treatments. Given the high mortality in men with a Gleason pattern of 5, combined modality local therapies and consideration of chemotherapies may be warranted.



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Original article
peer-reviewed

Risk of Death from Prostate Cancer with and without Definitive Local Therapy when Gleason Pattern 5 is Present: A Surveillance, Epidemiology, and End Results Analysis


Author Information

Jonathan Frandsen

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Andrew Orton

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Dennis Shrieve

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Jonathan Tward Corresponding Author

Radiation Oncology, University of Utah Huntsman Cancer Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Jonathan Tward declare(s) a grant and personal fees from Myriad. This funding is outside of the submitted work.

Acknowledgements

The authors would like to thank Michelle Denney for assistance in copy editing.


Original article
peer-reviewed

Risk of Death from Prostate Cancer with and without Definitive Local Therapy when Gleason Pattern 5 is Present: A Surveillance, Epidemiology, and End Results Analysis


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Original article
peer-reviewed

Risk of Death from Prostate Cancer with and without Definitive Local Therapy when Gleason Pattern 5 is Present: A Surveillance, Epidemiology, and End Results Analysis

  • Author Information
    Jonathan Frandsen

    Radiation Oncology, University of Utah Huntsman Cancer Hospital

    Andrew Orton

    Radiation Oncology, University of Utah Huntsman Cancer Hospital

    Dennis Shrieve

    Radiation Oncology, University of Utah Huntsman Cancer Hospital

    Jonathan Tward Corresponding Author

    Radiation Oncology, University of Utah Huntsman Cancer Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Jonathan Tward declare(s) a grant and personal fees from Myriad. This funding is outside of the submitted work.

    Acknowledgements

    The authors would like to thank Michelle Denney for assistance in copy editing.


    Article Information

    Published: July 10, 2017

    DOI

    10.7759/cureus.1453

    Cite this article as:

    Frandsen J, Orton A, Shrieve D, et al. (July 10, 2017) Risk of Death from Prostate Cancer with and without Definitive Local Therapy when Gleason Pattern 5 is Present: A Surveillance, Epidemiology, and End Results Analysis. Cureus 9(7): e1453. doi:10.7759/cureus.1453

    Publication history

    Received by Cureus: August 11, 2016
    Peer review began: September 14, 2016
    Peer review concluded: June 09, 2017
    Published: July 10, 2017

    Copyright

    © Copyright 2017
    Frandsen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Purpose

The purpose is to evaluate the patterns of care and comparative effectiveness for cause-specific and overall survival of definitive local treatments versus conservatively managed men with a primary or secondary Gleason pattern of 5.

Methods and materials

Patients diagnosed from 2004 to 2012 with a primary or secondary Gleason pattern of 5 N0M0 prostate cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier and Cox regression analyses were used to estimate the survival.

Results

We identified 20,560 men. Median age and follow-up were 68 years and 4.33 years, respectively. At eight years, cause-specific survival (CSS) was 86.6% and 57.4% of those receiving and not receiving definitive local treatments, respectively. For CSS multivariate analysis, the following were significant: age, race, insurance status, total Gleason Score, T-stage, and type or omission of definitive local treatments. Compared to prostatectomy alone, men not undergoing definitive local treatments had the highest risk of death (HR: 6.07; 95% CI: 5.19-7.10). Those undergoing external beam radiotherapy alone (HR: 2.11; 95% CI: 1.80-2.48) were also at elevated risk of death. The number needed to treat (NNT) to prevent a prostate cancer death at eight years was three persons.

Conclusions

Death from prostate cancer with a primary or secondary Gleason pattern of 5 histology without definitive local treatment is high. In this hypothesis-generating study, we found that men with a limited life expectancy (less than eight years) and non-metastatic Gleason pattern of 5 disease may benefit from definitive local treatments. Given the high mortality in men with a Gleason pattern of 5, combined modality local therapies and consideration of chemotherapies may be warranted.



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Create a free account to continue reading this article.

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Jonathan Frandsen

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Andrew Orton

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Dennis Shrieve

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Jonathan Tward

Radiation Oncology, University of Utah Huntsman Cancer Hospital

For correspondence:
jonathan.tward@hci.utah.edu

Jonathan Frandsen

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Andrew Orton

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Dennis Shrieve

Radiation Oncology, University of Utah Huntsman Cancer Hospital

Jonathan Tward

Radiation Oncology, University of Utah Huntsman Cancer Hospital

For correspondence:
jonathan.tward@hci.utah.edu