From the Guidelines
The prognosis for recurrent prostate cancer with a Gleason score of 4+3 is generally guarded, with a 5-year survival rate of approximately 70-80% after recurrence, and treatment options including salvage radiation therapy and systemic therapy with androgen deprivation therapy (ADT) and newer agents like abiraterone or enzalutamide.
Key Factors Influencing Prognosis
- PSA doubling time
- Time to recurrence after initial treatment
- Location of recurrence
Treatment Options
- Salvage radiation therapy for local recurrence, with doses of 66-70 Gy delivered over 6-7 weeks, often combined with ADT such as leuprolide 7.5 mg monthly injections for 6-24 months 1
- Systemic therapy with ADT for metastatic recurrence, potentially adding newer agents like abiraterone (1000 mg daily with prednisone 5 mg daily) or enzalutamide (160 mg daily) 1
Importance of Regular Monitoring
Regular PSA monitoring every 3-6 months and imaging studies are essential for tracking disease progression and adjusting treatment accordingly, with early intervention for recurrence generally offering better outcomes, particularly when the PSA level is still relatively low (ideally below 0.5 ng/mL for local salvage therapy) 1
Disease Aggressiveness
The higher proportion of pattern 4 in this Gleason score indicates more aggressive disease with greater potential for metastasis compared to 3+4 scores, emphasizing the need for careful management and consideration of the latest treatment guidelines 1
From the Research
Prognosis for Recurrent Prostate Cancer with a 4+3 Gleason Score
The prognosis for recurrent prostate cancer with a 4+3 Gleason score is influenced by various factors, including the effectiveness of androgen deprivation therapy (ADT) and the patient's overall health.
- The Gleason score is a significant predictor of cancer behavior and prognosis, with higher scores indicating more aggressive disease 2.
- Studies have shown that ADT can improve survival outcomes in patients with high-risk prostate cancer, including those with a Gleason score of 7 or higher 3, 4.
- The optimal duration of ADT varies depending on the patient's Gleason score, with longer durations potentially benefiting patients with higher Gleason scores 3, 4.
- A study found that patients with a Gleason score of 8-10 had inferior overall survival compared to those with a Gleason score of 4, but this difference was not significant when patients received long-term ADT or lifelong ADT 3.
- Another study suggested that low dihydrotestosterone levels in the prostate may be sufficient to propagate the growth of aggressive prostate cancer, and that the prostate with aggressive prostate cancer can produce androgens from adrenal precursors more autonomously than the prostate with non-aggressive prostate cancer 5.
- The use of neoadjuvant ADT before radiotherapy can reduce prostate volume, relieve lower urinary tract symptoms, and improve quality of life in men with intermediate- to high-risk prostate cancer 6.