Patients with biopsy gleason 9 and 10 prostate cancer have significantly worse outcomes compared to patients with gleason 8 disease

Che Kai Tsao, Kathryn P. Gray, Mari Nakabayashi, Carolyn Evan, Philip W. Kantoff, Jiaoti Huang, Matthew D. Galsky, Mark Pomerantz, William K. Oh

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Purpose We examined differences in outcome in patients with biopsy Gleason score 8 vs 9-10 who received definitive local therapy. Materials and Methods Using an institutional database we identified a cohort of 847 patients with biopsy Gleason 8-10 disease who received definitive local therapy with radiation therapy or radical prostatectomy between January 2001 and December 2011. Multivariable Cox modeling was used to assess the association of Gleason score 8 vs 9-10 with time to biochemical recurrence, metastasis and overall survival, and evaluate treatment by Gleason score interaction. Median followup in the cohort was 5.3 years. Results Baseline patient characteristics were similar for biopsy Gleason 8 vs 9-10. Gleason 9-10 disease was associated with higher prostate specific antigen at diagnosis. As local treatment such patients were also more likely to have received radiation therapy (58% vs 46%, p = 0.001) and neoadjuvant/adjuvant androgen deprivation therapy (64% vs 49%, p <0.001). Those with higher grade disease were at increased risk for metastasis (HR 1.41, 95% CI 1.11-1.79). There was a trend toward an increased risk of death in Gleason 9-10 vs 8 cases (HR 1.28, 95% CI 0.98-1.66). The increased risk of death for Gleason 9-10 was mainly observed in patients treated with radical prostatectomy with or without additional radiation therapy (HR 1.74, 95% CI 1.15-2.65). Conclusions Patients with localized biopsy Gleason 9-10 disease treated with definitive local therapy had worse outcomes than those diagnosed with biopsy Gleason 8 disease. Clinical trials are urgently needed that incorporate newer approaches to Gleason 9-10 cancer.

Original languageEnglish
Pages (from-to)91-97
Number of pages7
JournalJournal of Urology
Issue number1
StatePublished - 2015


  • biopsy
  • mortality
  • neoplasm grading
  • prognosis
  • prostatic neoplasms


Dive into the research topics of 'Patients with biopsy gleason 9 and 10 prostate cancer have significantly worse outcomes compared to patients with gleason 8 disease'. Together they form a unique fingerprint.

Cite this