Are all grade group 4 prostate cancers created equal? Implications for the applicability of the novel grade grouping

Giorgio Gandaglia, Robert Jeffrey Karnes, Arjun Sivaraman, Marco Moschini, Nicola Fossati, Emanuele Zaffuto, Paolo Dell'Oglio, Xavier Cathelineau, Francesco Montorsi, Rafael Sanchez-Salas, Alberto Briganti

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background: According to the novel prostate cancer (PCa) grade grouping, men with Gleason score 8 should be included in the grade group 4 regardless of primary and secondary scores. We aimed at evaluating the effect of Gleason patterns on the risk of recurrence in men with grade group 4 PCa. Patients and methods: Overall, 1,089 patients treated with radical prostatectomy with grade group 4 PCa at final pathology were identified. Biochemical recurrence (BCR) was defined as 2 consecutive prostate-specific antigen values≥0.2. ng/ml and rising. Clinical recurrence (CR) was defined as positive imaging after BCR. Kaplan-Meier analyses assessed time to BCR and CR. Multivariable Cox regression analyses assessed the impact of Gleason patterns on the risk of BCR and CR. Results: Overall, 295 (27.1%), 651 (59.8%), and 143 (13.1%) patients had pathologic Gleason pattern 3+5, 4+4, and 5+3. Overall, 435 (39.9%) patients had positive margins and 439 (30.2%), 300 (27.5%), 350 (32.1%), and 216 (19.8%) had pT2, pT3a, pT3b/4, and pN1 disease. Median follow-up was 83 months. Overall, 536 and 221 patients experienced BCR and CR. The 10-year BCR- and CR-free survival rates were 42.9% and 67.5% vs. 38.3% and 59.7% vs. 40.6% and 50.4% for patients with pathologic Gleason pattern 3+5 vs. 4+4 vs. 5+3, respectively (all P≤0.005). In multivariable analyses, patients with Gleason pattern 3+5 were at lower risk of BCR compared to those with 4+4 (P = 0.002). Men with Gleason pattern 3+5 were at lower risk of CR compared to those with 4+4 and 5+3 (all P≤ 0.01). Conclusions: Patients with a primary Gleason score 3 are at reduced risk of recurrence as compared to their counterparts with 4 or 5. Primary and secondary Gleason scores should be considered to stratify the risk of recurrence after surgery in patients with grade group 4 PCa.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Oct 26 2016

Keywords

  • Biochemical recurrence
  • Gleason score
  • Novel grade grouping
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

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    Gandaglia, G., Karnes, R. J., Sivaraman, A., Moschini, M., Fossati, N., Zaffuto, E., Dell'Oglio, P., Cathelineau, X., Montorsi, F., Sanchez-Salas, R., & Briganti, A. (Accepted/In press). Are all grade group 4 prostate cancers created equal? Implications for the applicability of the novel grade grouping. Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2017.02.012