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



Mori K^{1, 2} ; Sharma V^{3, 4} ; Comperat EM⁵ ; Sato S⁶ ; Laukhtina E^{1, 7} ; Schuettfort VM^{1, 8} ; Pradere B^{1, 9} ; Parizi MK^{1, 10} ; Karakiewicz PI¹¹ ; Egawa S² ; Tilki D^{12, 13} ; Boorjian SA³ ; Shariat SF^{1, 6, 14, 15, 16, 17, 18, 19}
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