Clinical Characteristics and Outcome of GleasonScore 10 Prostate Cancer on Core BiopsyTreated by External Radiotherapyand Hormone Therapy

Objective To evaluate the clinical characteristics and outcomes of patients with Gleason score 10prostate cancer treated by external radiotherapy and hormone therapy.Methods From January 2003 to March 2014, 1832 patients with prostate cancer were treated,among which 9 patients （represented 0.49%） were identified as Gleason score 10 disease on prostate corebiopsy without distant metastases when first diagnosed. All 9 patients were treated by whole pelvic externalradiotherapy （The whole pelvic dose was 50.0 Gy and the boost dose ranged from 76.2 to 78.0 Gy） andlong-term hormone therapy. We assessed the clinical characteristics, treatment outcomes and treatmenttoxicities. Survival curves were calculated using the Kaplan-Meier method.Results The median follow-up was 4.8 years. Six patients＇ pre-treatment prostate-specific antigen（PSA） levels were lower than 20.0 μg/L and three patients＇ pre-treatment PSA levels were higher than 70.0μg/L. The median percentage of positive biopsy cores was 91%. Three, four and two cases were classified asT2c, T3a and T3b stage, respectively. Three cases were assessed as N1 stage. The 5-year biochemicalfailure-free survival, distant metastasis-free survival, cancer specific survival and overall survival rates were28.6%, 57.1%, 66.7% and 57.1%, respectively. Five patients experienced grade 1-2 acute gastrointestinaltoxicities and six patients complained of grade 1-2 acute genitourinary toxicities. No bone fracture orcardiovascular disease was detected.Conclusions Gleason score 10 prostate cancer on core biopsy is usually combined with other highrisk factors. The pre-treatment PSA levels lie in two extremes. Timely and active treatments are urgent neededbecause unfavourable oncological outcomes are often presented.