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Limitations in Predicting Organ Confined Prostate Cancer in Patients with Gleason Pattern 4 on Biopsy: Implications for Active Surveillance

2016; Lippincott Williams & Wilkins; Volume: 197; Issue: 1 Linguagem: Inglês

10.1016/j.juro.2016.07.076

1527-3792

Nathan Perlis, Rashid K. Sayyid, Andrew Evans, Theodorus van der Kwast, Ants Toi, Antonio Finelli, Girish S. Kulkarni, Rob Hamilton, Alexandre R. Zlotta, John Trachtenberg, Sangeet Ghai, Neil Fleshner,

Urologic and reproductive health conditions

No AccessJournal of UrologyAdult Urology1 Jan 2017Limitations in Predicting Organ Confined Prostate Cancer in Patients with Gleason Pattern 4 on Biopsy: Implications for Active Surveillance Nathan Perlis, Rashid Sayyid, Andrew Evans, Theodorus Van Der Kwast, Ants Toi, Antonio Finelli, Girish Kulkarni, Rob Hamilton, Alexandre R. Zlotta, John Trachtenberg, Sangeet Ghai, and Neil E. Fleshner Nathan PerlisNathan Perlis Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada , Rashid SayyidRashid Sayyid Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada , Andrew EvansAndrew Evans Department of Pathology, University Health Network, University of Toronto, Ontario, Canada , Theodorus Van Der KwastTheodorus Van Der Kwast Department of Pathology, University Health Network, University of Toronto, Ontario, Canada , Ants ToiAnts Toi Joint Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada , Antonio FinelliAntonio Finelli Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada , Girish KulkarniGirish Kulkarni Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada , Rob HamiltonRob Hamilton Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada , Alexandre R. ZlottaAlexandre R. Zlotta Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada , John TrachtenbergJohn Trachtenberg Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada , Sangeet GhaiSangeet Ghai Joint Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada , and Neil E. FleshnerNeil E. Fleshner Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada View All Author Informationhttps://doi.org/10.1016/j.juro.2016.07.076AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In prostate cancer biopsy Gleason score predicts stage and helps determine active surveillance suitability. Evidence suggests that small incremental differences in the quantitative percent of Gleason pattern 4 on biopsy stratify disease extent, biochemical failure following surgery and eligibility for active surveillance. We explored the overall quantitative percent of Gleason pattern 4 levels and adverse outcomes in patients with low and intermediate risk prostate cancer to whom active surveillance may be offered under expanded criteria. Materials and Methods: We analyzed the records of patients with biopsy Gleason score 6 (3 + 3) or 7 (3 + 4) who underwent radical prostatectomy from January 2008 to August 2015. Age, prostate specific antigen, Gleason score, quantitative percent of Gleason pattern 4, overall percent positive cores (percent of prostate cancer) and clinical stage were explored as predictors of nonorgan confined disease and time to failure after radical prostatectomy. Results: In 1,255 patients biopsy Gleason score 7 (3 + 4) was associated with T3 or greater disease at radical prostatectomy in 35.0% compared with Gleason score 6 (3 + 3) in 19.0% (p <0.001). On multivariate analysis for each quantitative percent of Gleason pattern 4 increase there were 2% higher odds of T3 or greater disease (OR 1.02, 95% CI 1.01–1.04, p <0.001). When stratified, patients with Gleason score 7 (3 + 4) only approximated the pT3 rates of Gleason score 6 (3 + 3) when prostate specific antigen was less than 8 ng/ml and the percent of prostate cancer was less than 15%. In those cases the quantitative percent of Gleason pattern 4 had less effect. Time to failure after radical prostatectomy was worse in Gleason score 7 (3 + 4) than 6 (3 + 3) cases. Conclusions: The quantitative percent of Gleason pattern 4 helps predict advanced disease and Gleason score 7 (3 + 4) is associated with worse outcomes. However, the impact of the quantitative percent of Gleason pattern 4 on adverse pathological and clinical outcomes is best used in combination with prostate specific antigen, age and disease volume since each has a greater impact on predicting nonorgan confined disease. The calculated absolute risk of T3 or greater can be used in shared decision making on prostate cancer treatment by patients and clinicians. References 1 : Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology2007; 69: 1095. Google Scholar 2 : Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer. J Urol2003; 169: 157. Link, Google Scholar 3 : Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Clin Oncol2005; 23: 6992. Google Scholar 4 : Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol2015; 33: 272. Google Scholar 5 : The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol2016; 40: 244. Google Scholar 6 : Long-term prognostic significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer: impact on prostate cancer specific survival. J Urol2006; 175: 547. Link, Google Scholar 7 : Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3?. J Clin Oncol2009; 27: 3459. Google Scholar 8 : Prognostic importance of Gleason 7 disease among patients treated with external beam radiation therapy for prostate cancer: results of a detailed biopsy core analysis. Int J Radiat Oncol Biol Phys2013; 85: 1254. Google Scholar 9 : Biological determinants of cancer progression in men with prostate cancer. JAMA1999; 281: 1395. Crossref, Medline, Google Scholar 10 : Clinical utility of quantitative Gleason grading in prostate biopsies and prostatectomy specimens. Eur Urol2016; 69: 592. Google Scholar 11 : Prognostic value of percent Gleason grade 4 at prostate biopsy on predicting prostatectomy pathology and recurrence. J Urol2016; 196: 405. Link, Google Scholar 12 : Active surveillance for the management of localized prostate cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol2016; 34: 2182. Google Scholar 13 : Gleason upgrading with time in a large prostate cancer active surveillance cohort. J Urol2015; 194: 79. Link, Google Scholar 14 : Metastatic prostate cancer in men initially treated with active surveillance. J Urol2016; 195: 1. Google Scholar 15 : The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol2005; 29: 1228. Google Scholar 16 : Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol2011; 29: 2185. Google Scholar 17 : Outcomes of active surveillance for men with intermediate-risk prostate cancer. J Clin Oncol2011; 29: 228. Google Scholar 18 : Prevalence of prostate cancer on autopsy: cross-sectional study on unscreened Caucasian and Asian men. J Natl Cancer Inst2013; 105: 1050. Google Scholar 19 : Construction of the Patient-Oriented Prostate Utility Scale (PORPUS): a multiattribute health state classification system for prostate cancer. J Clin Epidemiol2000; 53: 920. Google Scholar 20 : Interactive digital slides with heat maps: a novel method to improve the reproducibility of Gleason grading. Virchows Arch2011; 459: 175. Google Scholar 21 : Diagnosis of "poorly formed glands" Gleason pattern 4 prostatic adenocarcinoma on needle biopsy: an interobserver reproducibility study among urologic pathologists with recommendations. Am J Surg Pathol2015; 39: 1331. Google Scholar 22 : Gleason grade 4 prostate adenocarcinoma patterns: an inter-observer agreement study among genitourinary pathologists. Histopathology2016; 10.1111/his.12976. Crossref, Google Scholar 23 : Standardization of Gleason grading among 337 European pathologists. Histopathology2013; 62: 247. Google Scholar 24 : The relationship between the extent of extraprostatic extension and survival following radical prostatectomy. Eur Urol2015; 67: 342. Google Scholar 25 : Digital quantification of five high-grade prostate cancer patterns, including the cribriform pattern, and their association with adverse outcome. Am J Clin Pathol2011; 136: 98. Google Scholar 26 : Architectural heterogeneity and cribriform pattern predict adverse clinical outcome for Gleason grade 4 prostatic adenocarcinoma. Am J Surg Pathol2013; 37: 1855. Google Scholar 27 : Disease-specific survival of patients with invasive cribriform and intraductal prostate cancer at diagnostic biopsy. Mod Pathol2016; 49: 1. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPerera M, Assel M, Benfante N, Vickers A, Reuter V, Carlsson S, Laudone V, Touijer K, Eastham J, Scardino P, Fine S and Ehdaie B (2022) Oncologic Outcomes of Total Length Gleason Pattern 4 on Biopsy in Men with Grade Group 2 Prostate CancerJournal of Urology, VOL. 208, NO. 2, (309-316), Online publication date: 1-Aug-2022.Xue A, Kalapara A, Ballok Z, Levy S, Sivaratnam D, Ryan A, Ramdave S, O'Sullivan R, Moon D, Grummet J and Frydenberg M (2021) 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography Maximum Standardized Uptake Value as a Predictor of Gleason Pattern 4 and Pathological Upgrading in Intermediate-Risk Prostate CancerJournal of Urology, VOL. 207, NO. 2, (341-349), Online publication date: 1-Feb-2022.Dean L, Assel M, Sjoberg D, Vickers A, Al-Ahmadie H, Chen Y, Gopalan A, Sirintrapun S, Tickoo S, Eastham J, Scardino P, Reuter V, Ehdaie B and Fine S (2018) Clinical Usefulness of Total Length of Gleason Pattern 4 on Biopsy in Men with Grade Group 2 Prostate CancerJournal of Urology, VOL. 201, NO. 1, (77-83), Online publication date: 1-Jan-2019.Iczkowski K (2018) Re: Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer: Considerations for Active SurveillanceJournal of Urology, VOL. 200, NO. 4, (905-905), Online publication date: 1-Oct-2018.Smith J (2016) This Month in Adult UrologyJournal of Urology, VOL. 197, NO. 1, (1-3), Online publication date: 1-Jan-2017. Volume 197Issue 1January 2017Page: 75-83Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsneoplasm gradingwatchful waitingprognosisprostatic neoplasmsprostatectomyMetricsAuthor Information Nathan Perlis Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Rashid Sayyid Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Andrew Evans Department of Pathology, University Health Network, University of Toronto, Ontario, Canada Financial interest and/or other relationship with GE Healthcare. More articles by this author Theodorus Van Der Kwast Department of Pathology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Ants Toi Joint Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada More articles by this author Antonio Finelli Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Girish Kulkarni Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Rob Hamilton Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Alexandre R. Zlotta Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada More articles by this author John Trachtenberg Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Sangeet Ghai Joint Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada More articles by this author Neil E. Fleshner Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Ontario, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...