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Impact of the Percentage of Positive Prostate Cores on Prostate Cancer–Specific Mortality for Patients With Low or Favorable Intermediate-Risk Disease

From the Department of Radiation Oncology and Pathology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; and Department of Statistics, University of Connecticut, Storrs, CT

Address reprint requests to Anthony V. D'Amico, MD, PhD, Brigham and Women's Hospital, Department of Radiation Oncology, 75 Francis St, L-2 Level, Boston, MA 02215; e-mail: adamico{at}lroc.harvard.edu

PURPOSE: We investigated whether pretreatment factors predicted time to prostate cancer–specific mortality (PCSM) after conventional-dose and conformal radiation therapy (CRT).

PATIENTS AND METHODS: Between 1988 and 2002, 421 patients with low (prostate-specific antigen [PSA] level 10 ng/mL and biopsy Gleason score 6) or favorable intermediate-risk (PSA > 10 to 15 ng/mL or biopsy Gleason score 3 + 4, but not both factors) disease underwent CRT (median dose, 70.4 Gy). Cox regression multivariable analysis was performed to determine whether the PSA level, Gleason score, T category, or the percentage of positive cores (% PC) predicted time to PCSM after CRT. After a median follow-up of 4.5 years, 117 (28%) patients have died.

RESULTS: The % PC was the only significant predictor (Cox P .03). The relative risk of PCSM after CRT for patients with 50% as compared with less than 50% PC was 10.4 (95% CI, 1.2 to 87; Cox P = .03), 6.1 (95% CI, 1.3 to 28.6; Cox P = .02), and 12.5 (95% CI, 1.5 to 107; Cox P = .02) in men with a PSA 10 and Gleason score 6, PSA 10 and Gleason score 7, and PSA 15 and Gleason score 6, respectively. By 5 years after CRT, 5% to 9% compared with less than 1% (log-rank P .01) of these patients experienced PCSM if they had 50% compared with less than 50% PC, respectively.

CONCLUSION: CRT dose-escalation techniques, the addition of hormonal therapy, or both should be considered in the management of patients with low or favorable intermediate-risk disease and 50% PC.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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