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Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer Publisher Pubmed



Mori K1, 2 ; Sharma V3, 4 ; Comperat EM5 ; Sato S6 ; Laukhtina E1, 7 ; Schuettfort VM1, 8 ; Pradere B1, 9 ; Sari Motlagh R1, 10 ; Mostafaei H1, 11 ; Quhal F1, 12 ; Kardoust Parizi M13 ; Abufaraj M14 ; Karakiewicz PI15 ; Egawa S2 Show All Authors
Authors
  1. Mori K1, 2
  2. Sharma V3, 4
  3. Comperat EM5
  4. Sato S6
  5. Laukhtina E1, 7
  6. Schuettfort VM1, 8
  7. Pradere B1, 9
  8. Sari Motlagh R1, 10
  9. Mostafaei H1, 11
  10. Quhal F1, 12
  11. Kardoust Parizi M13
  12. Abufaraj M14
  13. Karakiewicz PI15
  14. Egawa S2
  15. Tilki D16, 17
  16. Boorjian SA3
  17. Shariat SF1, 7, 14, 18, 19, 20, 21, 22
Show Affiliations
Authors Affiliations
  1. 1. Department of Urology, Medical University of Vienna, Vienna, Austria
  2. 2. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
  3. 3. Department of Urology, Mayo Clinic, Rochester, MN, United States
  4. 4. Department of Urology, VA Health Services Research and Development Fellowship, University of California, Los Angeles, CA, United States
  5. 5. Department of Pathology, Hopital Tenon, Sorbonne University, Paris, France
  6. 6. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
  7. 7. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
  8. 8. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  9. 9. Department of Urology, University Hospital of Tours, Tours, France
  10. 10. Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  11. 11. Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
  12. 12. Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
  13. 13. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  14. 14. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
  15. 15. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
  16. 16. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  17. 17. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  18. 18. Department of Urology, Weill Cornell Medical College, New York, NY, United States
  19. 19. Department of Urology, University of Texas Southwestern, Dallas, TX, United States
  20. 20. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
  21. 21. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
  22. 22. European Association of Urology Research Foundation, Arnhem, Netherlands

Source: Annals of Surgical Oncology Published:2021


Abstract

Background: Grade group (GG) 4 prostate cancer (PC) is considered a single entity; however, there are questions regarding prognostic heterogeneity. This study assessed the prognostic differences among various Gleason scores (GSs) classified as GG 4 PC on biopsy before radical prostatectomy (RP). Methods: We conducted a multicenter retrospective study, and a total of 1791 patients (GS 3 + 5: 190; GS 4 + 4: 1557; and GS 5 + 3: 44) with biopsy GG 4 were included for analysis. Biochemical recurrence (BCR)-free survival, cancer-specific survival, and overall survival were analyzed using the Kaplan–Meier method and the log-rank test. Logistic regression analysis was performed to identify factors associated with high-risk surgical pathologic features. Cox regression models were used to analyze time-dependent oncologic endpoints. Results: Over a median follow-up of 75 months, 750 patients (41.9%) experienced BCR, 146 (8.2%) died of any causes, and 57 (3.2%) died of PC. Biopsy GS 5 + 3 was associated with significantly higher rates of GS upgrading in RP specimens than GS 3 + 5 and GS 4 + 4. On multivariable analysis adjusted for clinicopathologic features, different GSs within GG 4 were significantly associated with BCR (p = 0.03) but not PC-specific or all-cause mortality. Study limitations include the lack of central pathological specimen evaluation. Conclusions: Patients with GG 4 at biopsy exhibited some limited biological and clinical heterogeneity. Specifically, GS 5 + 3 had an increased risk of GS upgrading. This can help individualize patients’ counseling and encourage further study to refine biopsy specimen-based GG classification. © 2021, The Author(s).
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