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Differential Prognostic Impact of Different Gleason Patterns in Grade Group 4 in Radical Prostatectomy Specimens Publisher Pubmed



Mori K1, 2 ; Sharma V3, 4 ; Comperat EM5 ; Sato S6 ; Laukhtina E1, 7 ; Schuettfort VM1, 8 ; Pradere B1, 9 ; Parizi MK1, 10 ; Karakiewicz PI11 ; Egawa S2 ; Tilki D12, 13 ; Boorjian SA3 ; Shariat SF1, 6, 14, 15, 16, 17, 18, 19
Authors
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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. VA Health Services Research and Development Fellowship, Department of Urology, University of California, Los Angeles, United States
  5. 5. Department of Pathology, Hopital Tenon, Sorbonne University, Paris, France
  6. 6. Departments 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. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  11. 11. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
  12. 12. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  13. 13. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  14. 14. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
  15. 15. Department of Urology, Weill Cornell Medical College, New York, NY, United States
  16. 16. Department of Urology, University of Texas Southwestern, Dallas, TX, United States
  17. 17. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
  18. 18. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
  19. 19. European Association of Urology Research Foundation, Arnhem, Netherlands

Source: European Journal of Surgical Oncology Published:2021


Abstract

Introduction: There are questions regarding whether grade group (GG) 4 prostate cancer (PC) is heterogeneous in terms of prognosis. We assessed prognostic differences in PC patients within GG 4 treated with radical prostatectomy (RP). Material and methods: Biochemical recurrence (BCR)-free, cancer-specific, and overall survival were analyzed in 787 PC patients with GG 4 based on RP pathology (Gleason score (GS) 3 + 5: 189, GS 4 + 4: 500, and GS 5 + 3: 98). Logistic regression analysis was performed to assess factors predictive of high-risk surgical pathological features. Cox regression models were used to evaluate potential prognostic factors of survival. Results: Within a median follow-up of 86 months, 378 patients (48.0%) experienced BCR and 96 patients (12.2%) died, 42 of whom (5.3%) died of PC. GS 5 + 3 was significantly associated with worse BCR-free and cancer-specific survival, as well as higher positive surgical margin, lymph node metastasis, extraprostatic extension, and non-organ-confined disease rates, than GS 3 + 5 and higher positive surgical margin, lymph node metastasis, extraprostatic extension, and non-organ-confined disease rates than GS 4 + 4 (P < 0.05). GS 4 + 4 was significantly associated with worse BCR-free survival and higher extraprostatic extension, and non-organ-confined disease rates than GS 3 + 5 (P < 0.05). Inclusion of the different Gleason patterns improved the discrimination of a model for prediction of all survival outcomes compared to standard prognosticators. Conclusions: There is considerable heterogeneity within GG 4 in terms of oncological and surgical pathological outcomes. Primary and secondary Gleason patterns should be considered to stratify high-risk PC patients after RP. © 2020 The Authors
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