Percentage of Gleason pattern 4 and tumor volume predict adverse pathological stage and margin status at radical prostatectomy in grade Group 2 and grade Group 3 prostate cancers. Issue 12 (29th June 2021)

• Record Type: Journal Article
• Authors: Iakymenko, Oleksii A.; Lugo, Isabella; Briski, Laurence M.; Nemov, Ivan; Punnen, Sanoj; Kwon, Deukwoo; Pollack, Alan; Stoyanova, Radka; Parekh, Dipen J.; Jorda, Merce; Gonzalgo, Mark L.; Kryvenko, Oleksandr N.
• Is Part Of: Prostate. Volume 81:Issue 12(2021)
• Page Start: 866
• Page End: 873
• Publication Date: 2021-06-29
• Subjects: outcome -- pattern 4 -- prostate cancer -- radical prostatectomy -- tumor volume; Prostate -- Diseases -- Periodicals; 616
• DOI: 10.1002/pros.24183
• Languages: English
• ISSNs: 0270-4137

Abstract

Abstract: Background: Increasing percentages of Gleason pattern 4 (GP4%) in radical prostatectomy (RP) correlate with an increased likelihood of nonorgan‐confined disease and earlier biochemical recurrence (BCR). However, there are no detailed RP studies assessing the impact of GP4% and corresponding tumor volume (TV) on extraprostatic extension (EPE), seminal vesicle (SV) invasion (SV+), and positive surgical margin (SM) status (SM+). Methods: In 1301 consecutive RPs, we analyzed each tumor nodule (TN) for TV, Grade Group (GG), presence of focal versus nonfocal EPE, SV+ , and SM+. Using GG1 (GP4% = 0) TNs as a reference, we recorded GP4% for all GG2 or GG3 TNs. We performed a multivariable analysis (MVA) using a mixed effects logistic regression that tested significant variables for risk of EPE, SV+, and SM+, as well as a multinomial logistic regression model that tested significant variables for risks of nonorgan‐confined disease (pT2+, pT3a, and pT3b) versus organ‐confined disease (pT2). Results: We identified 3231 discrete TNs ranging from 1 to 7 (median: 2.5) per RP. These included GG1 ( n = 2115), GG2 ( n = 818), GG3 ( n = 274), and GG4 ( n = 24) TNs. Increasing GP4% weakly paralleled increasing TV (tau = 0.07, p < .001). In MVA, increasing GP4% and TV predicted a greater likelihood of EPE (odds ratio [OR]: 1.03 and 4.41), SV+ (OR: 1.03 and 3.83), and SM+ (1.01, p = .01 and 2.83), all p < .001. Our multinomial logistic regression model demonstrated an association between GP4% and the risk of EPE (i.e., pT3a and pT3b disease), as well as an association between TV and risk of upstaging (all p < .001). Conclusions: Both GP4% and TV are independent predictors of adverse pathological stage and margin status at RP. However, the risks for adverse outcomes associated with GP4% are marginal, while those for TV are strong. The prognostic significance of GP4% on BCR‐free survival has not been studied controlling for TV and other adverse RP findings. Whether adverse pathological stage and margin status associated with larger TV could decrease BCR‐free survival to a greater extent than increasing RP GP4% remains to be studied.