A Gleason Score of 7 is often looked at as a middle range score, but clearly not as serious as an 8 or 9 score. Some recently combined research performed at the Department of Urology, University of Washington School of Public Health, Seattle, Washington and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washingtontook another look at that middle score of Gleason 7 and determined that not all 7s are the same.
They studied the different Gleason patterns as it pertains to prostate cancer specific mortality. Specifically,they evaluated the differences of the prostate specific mortality outcomes between the Gleason 7 scores of 4+3 vs. 3+4.
Their research sample consisted of men between 40 to 64 years old who were diagnosed with prostate cancer between the years of 1993 and 1996 in King County, Washington. They evaluated the recurrence/progression rates by using a follow-up survey and a medical record review. The mortality numbers and the cause of death were obtained from the Seattle-Puget Sound Surveillance, Epidemiology and End Results registry. Statistical analysis was by Cox proportional hazards regression analysis.
In the sample of 753 men with prostate cancer, 65 prostate cancer specific deaths occurred during a median follow-up of 13.2 years. The 10-year prostate cancer specific survival rate for men with a Gleason 6 or less, 3 + 4, 4 + 3 and 8-10 disease was 98.4%, 92.1%, 76.5% and 69.9%, respectively. Compared to patients with Gleason 3 + 4 disease those with Gleason 4 + 3 tumors were at increased risk for prostate cancer specific mortality in the unadjusted and multivariate models (HR 2.80, 95% CI 1.26-6.18 and HR 2.12, 95% CI 0.87-5.17, respectively).
In men undergoing curative therapy with radical prostatectomy or radiation therapy there was an increased risk of recurrence/progression (HR 2.1, 95% CI 1.08-4.08) and prostate cancer specific mortality (HR 3.17, 95% CI 1.04-9.67) in those with Gleason 4 + 3 vs 3 + 4 tumors in the multivariate models. No difference in prostate cancer specific mortality was seen between Gleason 4 + 3 and 8-10 tumors.
The bottom line was that a Gleason 7 prostate cancer shows different mortality results with Gleason 3 + 4 and 4 + 3. Mortality rates for Gleason scores of 3+4 are similar to Gleason 3+3 scores while Gleason 4+3 are similar to the more aggressive Gleason 8 scores.
These data provide important information for counseling patients with Gleason 7 prostate cancer on the natural history of the disease and may inform treatment decisions.
J Urol. 2009 Oct 15. Epub ahead of print.
doi:10.1016/j.juro.2009.08.026, Wright JL, Salinas CA, Lin DW, Kolb S, Koopmeiners J, Feng Z, Stanford JL.
Joel T Nowak MA, MSW