From the Guidelines
A Gleason score of 9 in prostate cancer indicates a poor prognosis, as this represents a high-grade, aggressive cancer with significant risk of progression and metastasis. Patients with this score typically have a 5-year survival rate of approximately 50-75%, though outcomes vary based on individual factors 1. Treatment usually involves a multimodal approach including radical prostatectomy, radiation therapy, and androgen deprivation therapy (ADT). Common ADT medications include leuprolide (Lupron) 7.5mg monthly or 22.5mg every 3 months, or goserelin (Zoladex) 3.6mg monthly or 10.8mg every 3 months. For more advanced disease, newer agents like abiraterone (1000mg daily with prednisone 5mg daily) or enzalutamide (160mg daily) may be added. The high Gleason score reflects significant cellular abnormality and disorganization in the prostate tissue, indicating cancer cells that have lost many normal regulatory functions, explaining their aggressive growth pattern and resistance to treatment.
Key considerations in managing a patient with a Gleason score of 9 include:
- Regular PSA monitoring every 3-6 months to assess for disease progression
- Imaging studies to evaluate for metastasis
- Multimodal treatment approach to optimize outcomes
- Consideration of newer agents for advanced disease The most recent guidelines from the National Comprehensive Cancer Network (NCCN) recommend a multimodal approach for patients with high-risk prostate cancer, including those with a Gleason score of 9 1.
Some important points to consider when treating patients with a Gleason score of 9 include:
- The importance of regular follow-up and monitoring to assess for disease progression
- The potential benefits and risks of different treatment approaches, including radical prostatectomy, radiation therapy, and ADT
- The role of newer agents, such as abiraterone and enzalutamide, in the management of advanced disease
- The need for individualized treatment planning, taking into account the patient's overall health, life expectancy, and personal preferences.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Prognosis of Gleason Score 9 Prostate Cancer
- The prognosis for a patient with a Gleason score of 9 in a prostate cancer diagnosis is generally poor, as it indicates a highly aggressive form of cancer 2, 3.
- Studies have shown that patients with Gleason scores 9-10 have a higher risk of distant metastasis and cancer-specific mortality compared to those with lower Gleason scores 2, 3.
- A study published in European Urology found that the 5-year and 10-year distant metastasis-free survival rates were significantly higher with extremely dose-escalated radiotherapy (94.6% and 89.8%) compared to external beam radiotherapy (78.7% and 66.7%) or radical prostatectomy (79.1% and 61.5%) 2.
- Another study published in European Urology Oncology found that the risks of prostate cancer death for men with Gleason scores 4+5+4, and 5+5 at 10 years were 0.45,0.56, and 0.66, respectively 3.
Treatment Options and Outcomes
- Treatment options for patients with Gleason score 9 prostate cancer include androgen deprivation therapy (ADT), radiotherapy, and radical prostatectomy 2, 4, 5, 6.
- A study published in The Lancet found that adding abiraterone acetate and prednisolone to ADT significantly improved metastasis-free survival and overall survival in patients with high-risk non-metastatic prostate cancer 4.
- Another study published in The Lancet found that combining ADT, docetaxel, and abiraterone improved overall survival and radiographic progression-free survival in patients with de novo metastatic castration-sensitive prostate cancer 5.
- Androgen deprivation therapy with Leuprolide acetate is a common treatment option for advanced prostate cancer, and has been shown to be effective in reducing tumor size and slowing disease progression 6.