Treating Gleason 9–10 Prostate Cancer 

According to Anthony V. D’Amico, MD, Ph.D., who is chief of the Division of Genitourinary Radiation Oncology and an institute physician at Dana-Farber Cancer Institute at Brigham and Women’s Hospital in Boston, “It makes logical sense that in these very aggressive prostate cancers, you need a multi-modality approach.”

D’Amico ran a study evaluating men with Gleason 9 and ten that compared treatment using radical prostatectomy (RP) plus adjuvant external beam radiotherapy (EBRT), and androgen deprivation therapy (ADT) (MaxRP), comparing using  EBRT, brachytherapy, and ADT (MaxRT).  He found that both treatments (the difference was that MaxRT used surgery instead of brachytherapy which was used in MaxRT) provided equivalent survival outcomes. The study was published in JAMA Oncology.

D’Amico and his fellow researchers evaluated 639 men (mean age, 65.83 years) with clinical T1–T4, N0M0 biopsy Gleason score 9–10 prostate cancer. There was no significant difference in the risks of prostate cancer-specific mortality and all-cause mortality in men who underwent MaxRP vs. those who underwent MaxRT. 

As important as this finding was D’Amico conclusion that this study should serve as a wake-up call that clinicians should be treating men who have a Gleason score of 9–10 and other adverse features upfront with a multi-modality approach. “Waiting for the PSA to rise is not as good as treating upfront,” D’Amico said in an interview with Cancer Network. “A lot of men with this cancer are going unaddressed for a long time.”

Amar U. Kishan, MD, who is an assistant professor in the Department of Radiation Oncology at the David Geffen School of Medicine at the University of California in Los Angeles, said these findings are similar to those of a more extensive study he and his colleagues conducted. Kishan’s research compared outcomes between patients with Gleason score 9–10 disease treated with RP and EBRT plus brachytherapy.