Cases Having a Gleason Score 3+4=7 With <5% of Gleason Pattern 4 in Prostate Needle Biopsy Show Similar Failure-free Survival and Adverse Pathology Prevalence to Gleason Score 6 Cases in a Radical Prostatectomy Cohort. (November 2019)

• Record Type: Journal Article
• Authors: Sato, Shun; Kimura, Takahiro; Yorozu, Takashi; Onuma, Hajime; Iwatani, Kosuke; Egawa, Shin; Ikegami, Masahiro; Takahashi, Hiroyuki
• Is Part Of: American journal of surgical pathology. Volume 43:Number 11(2019)
• Publication Date: 2019-11
• Subjects: prostate cancer -- Gleason score -- prostate needle biopsy -- survival -- radical prostatectomy; Pathology, Surgical -- Periodicals; 617.0705
• DOI: 10.1097/PAS.0000000000001345
• Languages: English
• ISSNs: 0147-5185

Abstract

Abstract : Recent discussions have suggested expanding the inclusion criteria for active prostate cancer surveillance to include cases with a Gleason score (GS) of 3+4=7. In this study, we examined this proposed use of a limited percent Gleason pattern 4 (%GP4) to identify candidates of active surveillance among 315 patients who underwent radical prostatectomy for prostate cancer with a GS of 6 or 3+4=7 via needle biopsy. The latter cases were divided into 4 groups using highest or overall %GP4 cut-off values of 5% and 10% as determined from prostate needle biopsies. The frequency of adverse pathology and risk of biochemical recurrence were compared between the GS 6 and both GS 3+4=7 groups. Adverse pathology was defined as a GS 4+3=7 or higher, pT3b staging or positive lymph node metastasis. Notably, the Gleason pattern 4 &lt;5% and GS 6 groups did not differ significantly in terms of the frequency of adverse pathology and risk of biochemical recurrence by the highest method. However, other highest Gleason pattern 4 categories had significantly higher frequencies and risks. Using the overall method, even the Gleason pattern 4 &lt;5% group had a significantly higher frequency of adverse pathology and risk of biochemical recurrence relative to the GS 6 group. In conclusion, our findings suggest that patients with a GS 3+4=7 on biopsy with a highest %GP4 &lt;5% are similar candidates for active surveillance to men with GS 6 cancers. Abstract : Supplemental Digital Content is available in the text.