From the Guidelines
The prognosis for a 75-year-old man with prostatic acinar adenocarcinoma, Gleason score 8/10, ISUP grade group 4, tumor volume 50%, and perineural invasion is generally unfavorable without appropriate treatment, with a recommended treatment approach of radical prostatectomy or radiation therapy combined with androgen deprivation therapy (ADT) for 2-3 years, as per the latest guidelines 1.
Key Considerations
- The high Gleason score (8/10) and ISUP grade group 4 indicate aggressive disease with poorly differentiated cancer cells, which is associated with a higher risk of progression and metastasis.
- The substantial tumor volume (50%) and presence of perineural invasion further suggest local advancement and increased risk of extraprostatic extension.
- According to the latest guidelines, patients with cN0 disease and high-risk factors, such as Gleason score 8, should be offered IMRT/VMAT plus IGRT in combination with long-term ADT and 2 years of abiraterone 1.
Treatment Options
- Radical prostatectomy (RP) may be considered as part of multimodal therapy, with the addition of adjuvant IMRT/VMAT plus IGRT in patients with pN0 disease and ISUP grade group 4-5 1.
- Radiation therapy, including IMRT/VMAT plus IGRT, with or without brachytherapy boost, is a recommended treatment option, particularly for patients with good urinary function 1.
- Androgen deprivation therapy (ADT) is a crucial component of treatment, with a recommended duration of at least 2 years 1.
Monitoring and Follow-up
- Regular PSA monitoring and imaging studies are essential to assess treatment response and detect potential recurrence or progression early.
- A prostate-specific membrane antigen positron emission tomography/computed tomography scan may be offered to men with a persistent PSA value of >0.2 ng/ml if the results influence subsequent treatment decisions 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Prognosis of Prostatic Acinar Adenocarcinoma
The prognosis for a 75-year-old man with prostatic acinar adenocarcinoma, Gleason score 8/10, International Society of Urological Pathology (ISUP) grade group 4, tumor volume 50%, and perineural invasion is as follows:
- The Gleason score of 8/10 indicates a high-grade tumor, which is associated with a poorer prognosis 2.
- The ISUP grade group 4 confirms the high-grade nature of the tumor, which is associated with a higher risk of disease progression and mortality 2.
- The tumor volume of 50% suggests a significant burden of disease, which may impact treatment outcomes and prognosis.
- The presence of perineural invasion is a poor prognostic factor, as it indicates that the tumor has invaded the nerves surrounding the prostate, which can lead to increased risk of recurrence and metastasis 3.
Survival Rates
- According to a study published in 2024, the 5-year prostate cancer-specific mortality (PCSM) rate for men with Gleason score 8 tumors is around 22% 2.
- Another study published in 2024 reported that the 10-year PCSM rate for men with Gleason score 9-10 tumors is around 45-66% 4.
- A study from 1997 reported that the 5-year survival rate for patients with Gleason score 8-10 tumors treated with adjuvant goserelin is around 66% 5.
Treatment Outcomes
- The treatment outcomes for this patient will depend on various factors, including the patient's overall health, tumor characteristics, and treatment options.
- According to a study published in 1998, patients with Gleason score 7-10 tumors and perineural invasion may benefit from adjuvant therapies or altered treatment programs 3.
- A study from 2024 suggested that the current debate about the benign nature of Gleason score 3+3=6 tumors is unhelpful to clinicians and patients, and that the correct strategy to address potential over-treatment is clinician and patient education 6.