Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer

Considerations for Active Surveillance

Derek J. Gearman, Alessandro Morlacco, John C. Cheville, Laureano J. Rangel, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Recent NCCN® (National Comprehensive Cancer Network®) Guidelines® show that patients with biopsy Gleason score 3 + 4/Grade Group 2 but otherwise favorable features are active surveillance candidates. However, little is known about the long-term outcomes compared to that in men in the low risk Gleason score 6/Grade Group 1 group. We sought to clarify the risk of adverse features and oncologic outcomes in surgically treated, favorable Grade Group 2 vs 1 cases. Materials and Methods: We queried our prospectively maintained radical prostatectomy database for all 8,095 patients with biopsy Grade Group 1 or 2 prostate cancer who otherwise fulfilled the NCCN low risk definition of prostate specific antigen less than 10 ng/ml and cT2a or less, and who underwent radical prostatectomy from 1987 to 2014. Multivariable logistic regression and Kaplan-Meier methods were used to compare pathological and oncologic outcomes. Results: Organ confined disease was present in 93.9% and 82.6% of Grade Group 1 and favorable intermediate risk Grade Group 2 cases while seminal vesicle invasion was noted in 1.7% and 4.7%, and nodal disease was noted in 0.3% and 1.8%, respectively (all p <0.0001). On multivariable logistic regression biopsy proven Grade Group 2 disease was associated with a threefold greater risk of nonorgan confined disease (OR 3.1, 95% CI 1.7–5.7, p <0.001). The incidence of late treatment (more than 90 days from surgery) in Grade Group 1 vs 2 was 3.1% vs 8.5% for hormonal therapy and 6.0% vs 12.2% for radiation (p <0.001). In the Grade Group 1 vs 2 cohorts the 10-year biochemical recurrence-free survival rate was 88.9% vs 81.2% and the 10-year systemic progression-free survival rate was 99% vs 96.5% (each p <0.001). Conclusions: Men at favorable risk with Grade Group 2 disease who are considering active surveillance should be informed of the risks of harboring adverse pathological features which impact secondary therapies and an increased risk of cancer progression.

Original languageEnglish (US)
Pages (from-to)1188-1195
Number of pages8
JournalJournal of Urology
Volume199
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Neoplasm Grading
Prostatic Neoplasms
Prostatectomy
Biopsy
Survival Rate
Logistic Models
Neoplasms
Seminal Vesicles
Prostate-Specific Antigen
Ambulatory Surgical Procedures
Disease-Free Survival
Therapeutics
Databases
Guidelines
Radiation
Recurrence
Incidence

Keywords

  • neoplasm grading
  • prostatectomy
  • prostatic neoplasms
  • risk factors
  • watchful waiting

ASJC Scopus subject areas

  • Urology

Cite this

Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer : Considerations for Active Surveillance. / Gearman, Derek J.; Morlacco, Alessandro; Cheville, John C.; Rangel, Laureano J.; Karnes, Robert Jeffrey.

In: Journal of Urology, Vol. 199, No. 5, 01.05.2018, p. 1188-1195.

Research output: Contribution to journalArticle

@article{07876ce180644e7196ef2de0cccc7064,
title = "Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer: Considerations for Active Surveillance",
abstract = "Purpose: Recent NCCN{\circledR} (National Comprehensive Cancer Network{\circledR}) Guidelines{\circledR} show that patients with biopsy Gleason score 3 + 4/Grade Group 2 but otherwise favorable features are active surveillance candidates. However, little is known about the long-term outcomes compared to that in men in the low risk Gleason score 6/Grade Group 1 group. We sought to clarify the risk of adverse features and oncologic outcomes in surgically treated, favorable Grade Group 2 vs 1 cases. Materials and Methods: We queried our prospectively maintained radical prostatectomy database for all 8,095 patients with biopsy Grade Group 1 or 2 prostate cancer who otherwise fulfilled the NCCN low risk definition of prostate specific antigen less than 10 ng/ml and cT2a or less, and who underwent radical prostatectomy from 1987 to 2014. Multivariable logistic regression and Kaplan-Meier methods were used to compare pathological and oncologic outcomes. Results: Organ confined disease was present in 93.9{\%} and 82.6{\%} of Grade Group 1 and favorable intermediate risk Grade Group 2 cases while seminal vesicle invasion was noted in 1.7{\%} and 4.7{\%}, and nodal disease was noted in 0.3{\%} and 1.8{\%}, respectively (all p <0.0001). On multivariable logistic regression biopsy proven Grade Group 2 disease was associated with a threefold greater risk of nonorgan confined disease (OR 3.1, 95{\%} CI 1.7–5.7, p <0.001). The incidence of late treatment (more than 90 days from surgery) in Grade Group 1 vs 2 was 3.1{\%} vs 8.5{\%} for hormonal therapy and 6.0{\%} vs 12.2{\%} for radiation (p <0.001). In the Grade Group 1 vs 2 cohorts the 10-year biochemical recurrence-free survival rate was 88.9{\%} vs 81.2{\%} and the 10-year systemic progression-free survival rate was 99{\%} vs 96.5{\%} (each p <0.001). Conclusions: Men at favorable risk with Grade Group 2 disease who are considering active surveillance should be informed of the risks of harboring adverse pathological features which impact secondary therapies and an increased risk of cancer progression.",
keywords = "neoplasm grading, prostatectomy, prostatic neoplasms, risk factors, watchful waiting",
author = "Gearman, {Derek J.} and Alessandro Morlacco and Cheville, {John C.} and Rangel, {Laureano J.} and Karnes, {Robert Jeffrey}",
year = "2018",
month = "5",
day = "1",
doi = "10.1016/j.juro.2017.11.116",
language = "English (US)",
volume = "199",
pages = "1188--1195",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer

T2 - Considerations for Active Surveillance

AU - Gearman, Derek J.

AU - Morlacco, Alessandro

AU - Cheville, John C.

AU - Rangel, Laureano J.

AU - Karnes, Robert Jeffrey

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Purpose: Recent NCCN® (National Comprehensive Cancer Network®) Guidelines® show that patients with biopsy Gleason score 3 + 4/Grade Group 2 but otherwise favorable features are active surveillance candidates. However, little is known about the long-term outcomes compared to that in men in the low risk Gleason score 6/Grade Group 1 group. We sought to clarify the risk of adverse features and oncologic outcomes in surgically treated, favorable Grade Group 2 vs 1 cases. Materials and Methods: We queried our prospectively maintained radical prostatectomy database for all 8,095 patients with biopsy Grade Group 1 or 2 prostate cancer who otherwise fulfilled the NCCN low risk definition of prostate specific antigen less than 10 ng/ml and cT2a or less, and who underwent radical prostatectomy from 1987 to 2014. Multivariable logistic regression and Kaplan-Meier methods were used to compare pathological and oncologic outcomes. Results: Organ confined disease was present in 93.9% and 82.6% of Grade Group 1 and favorable intermediate risk Grade Group 2 cases while seminal vesicle invasion was noted in 1.7% and 4.7%, and nodal disease was noted in 0.3% and 1.8%, respectively (all p <0.0001). On multivariable logistic regression biopsy proven Grade Group 2 disease was associated with a threefold greater risk of nonorgan confined disease (OR 3.1, 95% CI 1.7–5.7, p <0.001). The incidence of late treatment (more than 90 days from surgery) in Grade Group 1 vs 2 was 3.1% vs 8.5% for hormonal therapy and 6.0% vs 12.2% for radiation (p <0.001). In the Grade Group 1 vs 2 cohorts the 10-year biochemical recurrence-free survival rate was 88.9% vs 81.2% and the 10-year systemic progression-free survival rate was 99% vs 96.5% (each p <0.001). Conclusions: Men at favorable risk with Grade Group 2 disease who are considering active surveillance should be informed of the risks of harboring adverse pathological features which impact secondary therapies and an increased risk of cancer progression.

AB - Purpose: Recent NCCN® (National Comprehensive Cancer Network®) Guidelines® show that patients with biopsy Gleason score 3 + 4/Grade Group 2 but otherwise favorable features are active surveillance candidates. However, little is known about the long-term outcomes compared to that in men in the low risk Gleason score 6/Grade Group 1 group. We sought to clarify the risk of adverse features and oncologic outcomes in surgically treated, favorable Grade Group 2 vs 1 cases. Materials and Methods: We queried our prospectively maintained radical prostatectomy database for all 8,095 patients with biopsy Grade Group 1 or 2 prostate cancer who otherwise fulfilled the NCCN low risk definition of prostate specific antigen less than 10 ng/ml and cT2a or less, and who underwent radical prostatectomy from 1987 to 2014. Multivariable logistic regression and Kaplan-Meier methods were used to compare pathological and oncologic outcomes. Results: Organ confined disease was present in 93.9% and 82.6% of Grade Group 1 and favorable intermediate risk Grade Group 2 cases while seminal vesicle invasion was noted in 1.7% and 4.7%, and nodal disease was noted in 0.3% and 1.8%, respectively (all p <0.0001). On multivariable logistic regression biopsy proven Grade Group 2 disease was associated with a threefold greater risk of nonorgan confined disease (OR 3.1, 95% CI 1.7–5.7, p <0.001). The incidence of late treatment (more than 90 days from surgery) in Grade Group 1 vs 2 was 3.1% vs 8.5% for hormonal therapy and 6.0% vs 12.2% for radiation (p <0.001). In the Grade Group 1 vs 2 cohorts the 10-year biochemical recurrence-free survival rate was 88.9% vs 81.2% and the 10-year systemic progression-free survival rate was 99% vs 96.5% (each p <0.001). Conclusions: Men at favorable risk with Grade Group 2 disease who are considering active surveillance should be informed of the risks of harboring adverse pathological features which impact secondary therapies and an increased risk of cancer progression.

KW - neoplasm grading

KW - prostatectomy

KW - prostatic neoplasms

KW - risk factors

KW - watchful waiting

UR - http://www.scopus.com/inward/record.url?scp=85044370087&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044370087&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2017.11.116

DO - 10.1016/j.juro.2017.11.116

M3 - Article

VL - 199

SP - 1188

EP - 1195

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 5

ER -