Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer.

Mori K, Sharma V, Comperat EM, Sato S, Laukhtina E, Schuettfort VM, Pradere B, Sari Motlagh R, Mostafaei H, Quhal F, Kardoust Parizi M, Abufaraj M, Karakiewicz PI, Egawa S, Tilki D, Boorjian SA, Shariat SF. Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer. Annals of Surgical Oncology. 2021 Dec 1; 28(13):9179-9187.

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Abstract:

BACKGROUND: Grade group (GG) 4 prostate cancer (PC) is considered a single entity; however, there are questions regarding prognostic heterogeneity. This study assessed the prognostic differences among various Gleason scores (GSs) classified as GG 4 PC on biopsy before radical prostatectomy (RP). METHODS: We conducted a multicenter retrospective study, and a total of 1791 patients (GS 3?+?5: 190; GS 4?+?4: 1557; and GS 5?+?3: 44) with biopsy GG 4 were included for analysis. Biochemical recurrence (BCR)-free survival, cancer-specific survival, and overall survival were analyzed using the Kaplan-Meier method and the log-rank test. Logistic regression analysis was performed to identify factors associated with high-risk surgical pathologic features. Cox regression models were used to analyze time-dependent oncologic endpoints. RESULTS: Over a median follow-up of 75 months, 750 patients (41.9%) experienced BCR, 146 (8.2%) died of any causes, and 57 (3.2%) died of PC. Biopsy GS 5?+?3 was associated with significantly higher rates of GS upgrading in RP specimens than GS 3?+?5 and GS 4?+?4. On multivariable analysis adjusted for clinicopathologic features, different GSs within GG 4 were significantly associated with BCR (p? = 0.03) but not PC-specific or all-cause mortality. Study limitations include the lack of central pathological specimen evaluation. CONCLUSIONS: Patients with GG 4 at biopsy exhibited some limited biological and clinical heterogeneity. Specifically, GS 5?+?3 had an increased risk of GS upgrading. This can help individualize patients' counseling and encourage further study to refine biopsy specimen-based GG classification.