Near‐diploidy: A new prognostic factor for clinically localized prostate cancer treated with external beam radiation therapy

Background. DNA ploidy is a significant prognostic factor in patients with prostate cancer. Using DNA/nuclear protein flow cytometry, a subpopulation of tumors with near‐diploid DNA is identifiable. The prognostic significance of near‐diploidy was examined. Methods. Paraffin‐embedded formalin fixed prostate tumor tissue from patients treated at M. D. Anderson Cancer Center with external beam radiation therapy was processed for DNA/nuclear protein flow cytometry. All patients had pretreatment and follow‐up serum prostate specific antigen (PSA) levels. Seventy‐six specimens were suitable for flow cytometric analysis. Tumors were classified as either diploid (n = 30), near‐diploid (n = 24), or nondiploid (n = 22, tetraploid and aneuploid). Median follow‐up time was 36 months. Results. Diploid tumors were associated with a significantly better actuarial outcome at 4 years, compared with near‐diploid tumors, using either biochemical relapse (rising PSA) or a composite end point of a rising PSA or clinical relapse (16% versus 52% relapse, P < 0.05, log‐rank). Moreover, patients who had nondiploid tumors had the worst prognosis (77% relapse, composite end point). No significant difference was observed between diploid and near‐diploid neoplasms regarding actuarial local control, freedom from metastasis, freedom from clinical relapse, or overall survival time. A Cox proportional hazards model, using the composite end point of a rising PSA or relapse, was performed with ploidy categorized as diploid, near‐diploid, and nondiploid; pretreatment PSA, DNA ploidy, and tumor grade were found to be independent prognostic factors. When ploidy was categorized as diploid or near‐diploid (nondiploid tumors excluded), pretreatment serum PSA and DNA ploidy were independent predictors of outcome. Ploidy remained an independent prognostic factor even when nondiploid tumors were excluded. Conclusions. These data show that patients who have near‐diploid tumors have an intermediate prognosis between the more favorable diploid tumors and the less favorable nondiploid tumors.