Purpose. We performed a retrospective study to determine the outcome of a modern cohort of patients with high-grade (Gleason score ≥ 8) prostate cancer treated with radical prostatectomy, radiation therapy, or hormone therapy. Methods. We identified 404 patients in the South Texas Veteran’s Healthcare System Tumor Registry diagnosed with high grade prostate cancer between 1998 and 2008. Mean follow-up was 4 . 6 2 ± 2 . 6 1 years. End points were biochemical failure-free survival, overall survival, metastasis-free survival, and cancer-specific survival. Results. 5-year overall survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 88.9%, 76.3%, and 58.9%, respectively. 5-year metastasis-free survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 96.8%, 96.6%, and 88.4%, respectively, and 5-year cancer-specific survival was 97.2%, 100%, and 89.9%, respectively. Patients with a Gleason score of 10 and pretreatment prostate-specific antigen > 20？ng/mL had decreased 5-year biochemical failure-free and cancer-specific survival. Patients with a pretreatment prostate-specific antigen > 20？ng/mL had decreased 5-year overall survival. Discussion. Even for patients with high-grade disease, the outcome is not as dire in the modern era regardless of primary treatment modality chosen. While there is room for improvement, we should not have a nihilistic impression of how these patients will respond to treatment. 1. Introduction In the modern era of prostate specific antigen (PSA) screening, thousands of men are diagnosed with prostate cancer each year that would have previously escaped detection. Of the estimated 218,000 American men diagnosed with prostate cancer in 2010 [1], men with high-grade disease (Gleason 8–10) are at greatest risk for adverse outcomes. Gleason score has long been shown to correlate well with risk for local extension, metastasis, and death [2]. While clinicians generally agree that men with high-grade disease require prompt therapy to limit disease-specific morbidity and mortality, the best treatment for these men remains controversial. As a result, they are treated with a variety of different options. Radical prostatectomy (RP) and radiation therapy (RT) remain the standard modalities for treatment of patients with prostate cancer. Hormone therapy (HT) is used either in combination with more definitive therapy or considered palliative treatment when used alone. Regardless of treatment, patients with high-grade prostate cancer have historically experienced
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