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Hilscher M, Røder A, Helgstrand JT, Klemann N, Brasso K, Vickers AJ, Stroomberg HV. Risk of prostate cancer and death after benign transurethral resection of the prostate-A 20-year population-based analysis. Cancer 2022; 128:3674-3680. [PMID: 35975979 PMCID: PMC9804454 DOI: 10.1002/cncr.34407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The oncological risks after benign histology on a transurethral resection of the prostate (TURP) remain largely unknown. Here, the risk of prostate cancer incidence and mortality following a benign histological assessment of TURP is investigated in a population-based setting. METHODS Between 1995 and 2016, 64,059 men in Denmark underwent TURP without prior biopsy of the prostate; 42,558 of these men had benign histology. The risks of prostate cancer, prostate cancer with a Gleason score ≥ 3 + 4, and prostate cancer-specific death were assessed with competing risks. Specific risks for pre-TURP prostate-specific antigen (PSA) levels at 10 and 15 years were visualized by locally estimated scatterplot smoothing. RESULTS The median age at TURP was 72 years (interquartile range [IQR], 65-78 years), and the median follow-up was 15 years (IQR, 10-19 years). The 10-year risks of any prostate cancer and prostate cancer with a Gleason score ≥ 3 + 4 and the 15-year risk of prostate cancer death showed clear visual relations with increasing PSA. The 15-year cumulative incidence of prostate cancer-specific death after benign TURP was 1.4% (95% confidence interval [CI], 1.3%-1.6%) for all men and 0.8% (95% CI, 0.6%-1.1%) for men with PSA levels <10 ng/ml. The primary limitation was exclusion due to missing PSA data. CONCLUSIONS Men with low PSA levels and a benign TURP can be reassured about their cancer risk and do not need to be monitored differently than any other men. Patients with high PSA levels can be considered for further follow-up with prostate magnetic resonance imaging. These findings add to the literature suggesting that normal histology from the prostate entails a low risk of death from the disease. LAY SUMMARY There is little knowledge about the oncological risks after the surgical treatment of benign prostatic hyperplasia. This study shows a very low risk of adverse oncological outcomes in men with prostate-specific antigen (PSA) levels below 10 ng/ml at the time of transurethral resection of the prostate. Patients with higher PSA levels may need more extensive follow-up.
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Affiliation(s)
- Maria Hilscher
- Copenhagen Prostate Cancer Center, Department of UrologyCenter for Cancer and Organ Disease, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of UrologyCenter for Cancer and Organ Disease, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - J. Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Department of UrologyCenter for Cancer and Organ Disease, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Nina Klemann
- Copenhagen Prostate Cancer Center, Department of UrologyCenter for Cancer and Organ Disease, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of UrologyCenter for Cancer and Organ Disease, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Andrew Julian Vickers
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Hein Vincent Stroomberg
- Copenhagen Prostate Cancer Center, Department of UrologyCenter for Cancer and Organ Disease, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
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Zelic R, Giunchi F, Fridfeldt J, Carlsson J, Davidsson S, Lianas L, Mascia C, Zugna D, Molinaro L, Vincent PH, Zanetti G, Andrén O, Richiardi L, Akre O, Fiorentino M, Pettersson A. Prognostic Utility of the Gleason Grading System Revisions and Histopathological Factors Beyond Gleason Grade. Clin Epidemiol 2022; 14:59-70. [PMID: 35082531 PMCID: PMC8784949 DOI: 10.2147/clep.s339140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background The International Society of Urological Pathology (ISUP) revised the Gleason system in 2005 and 2014. The impact of these changes on prostate cancer (PCa) prognostication remains unclear. Objective To evaluate if the ISUP 2014 Gleason score (GS) predicts PCa death better than the pre-2005 GS, and if additional histopathological information can further improve PCa death prediction. Patients and Methods We conducted a case–control study nested among men in the National Prostate Cancer Register of Sweden diagnosed with non-metastatic PCa 1998–2015. We included 369 men who died from PCa (cases) and 369 men who did not (controls). Two uro-pathologists centrally re-reviewed biopsy ISUP 2014 Gleason grading, poorly formed glands, cribriform pattern, comedonecrosis, perineural invasion, intraductal, ductal and mucinous carcinoma, percentage Gleason 4, inflammation, high-grade prostatic intraepithelial neoplasia (HGPIN) and post-atrophic hyperplasia. Pre-2005 GS was back-transformed using i) information on cribriform pattern and/or poorly formed glands and ii) the diagnostic GS from the registry. Models were developed using Firth logistic regression and compared in terms of discrimination (AUC). Results The ISUP 2014 GS (AUC = 0.808) performed better than the pre-2005 GS when back-transformed using only cribriform pattern (AUC = 0.785) or both cribriform and poorly formed glands (AUC = 0.792), but not when back-transformed using only poorly formed glands (AUC = 0.800). Similarly, the ISUP 2014 GS performed better than the diagnostic GS (AUC = 0.808 vs 0.781). Comedonecrosis (AUC = 0.811), HGPIN (AUC = 0.810) and number of cores with ≥50% cancer (AUC = 0.810) predicted PCa death independently of the ISUP 2014 GS. Conclusion The Gleason Grading revisions have improved PCa death prediction, likely due to classifying cribriform patterns, rather than poorly formed glands, as Gleason 4. Comedonecrosis, HGPIN and number of cores with ≥50% cancer further improve PCa death discrimination slightly.
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Affiliation(s)
- Renata Zelic
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Correspondence: Renata Zelic Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, K2 Medicin, Solna, K2 Klinisk epidemiologi K Ekström Smedby, Stockholm, 171 77, SwedenTel +46703136037Fax +46851779304 Email
| | - Francesca Giunchi
- Pathology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jonna Fridfeldt
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sabina Davidsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Luca Lianas
- Data-Intensive Computing Division, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Pula, Italy
| | - Cecilia Mascia
- Data-Intensive Computing Division, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Pula, Italy
| | - Daniela Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, and CPO-Piemonte, Turin, Italy
| | - Luca Molinaro
- Division of Pathology, A.O. Città della Salute e della Scienza Hospital, Turin, Italy
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Zanetti
- Data-Intensive Computing Division, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Pula, Italy
| | - Ove Andrén
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, and CPO-Piemonte, Turin, Italy
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Andreas Pettersson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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3
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Zhang W, Wang G, Lan F, Wang H, Shen D, Xu K, Xu T, Hu H. Exploration on Gleason score variation trend of patients with prostate carcinoma from 1996 to 2019: a retrospective single center study. Gland Surg 2021; 10:607-617. [PMID: 33708544 DOI: 10.21037/gs-20-659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Gleason score (GS) is one of the stronger prognostic factors and is integral to the management of prostate carcinoma. Subsequent modifications, recommended by the International Society of Urological Pathology in 2005 and 2014, enabled accurate prediction of prognosis. The present study investigated GS variation trend of patients with prostate carcinoma from 1996 to 2019 and offered an overview of GS changes with age, specimen type, histopathological type and serum prostate specific antigen (PSA). Methods One thousand three hundred and seventy-six patients, admitted to Peking University People's Hospital in 1996 to 2019, were divided into 1996 to 2006, 2007 to 2015 and 2016 to 2019 groups. Data, including demographic characteristics, GS, primary and secondary grade and percentage of primary and secondary grade of each group, were collected and analyzed. The population distribution and average of GS was evaluated, after segmented and stratified by age, type of specimen, histopathological type and PSA. Results The average of age and PSA of each cohort had no obvious change. The average of total GS fluctuated among three cohorts with statistically significant differences. The distribution of age and PSA did not differ among cohorts. The distribution of total and primary GS shifted, with more patients detected as total GS higher than 6 (86.1%), and more primary grade higher than 3 (56.7%) in 2016-2019. After segmented and stratified by age, specimen type, histological type and PSA, the population percentage of GS over 6 was significantly higher in 2016-2019 than 1996-2006 and 2007-2015 in patients aged younger than 80 years (age <60, 89.6%, age 60-69, 82.0%, age 70-79, 87.7%). Patients, aged below 80 years in 2016-2019, were detected with higher total GS. Conclusions In the present study, GS in patients with prostate carcinoma showed a upward trend. Primary grade, age, serum PSA and specimen type were the main reasons for GS changing while secondary grade, tissue types and diagnostic criteria influenced less.
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Affiliation(s)
- Weiyu Zhang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Gongwei Wang
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Fengling Lan
- Department of Human Resources, Peking University People's Hospital, Beijing, China
| | - Huanrui Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Hao Hu
- Department of Urology, Peking University People's Hospital, Beijing, China
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De Luca S, Fiori C, Bollito E, Garrou D, Aimar R, Cattaneo G, De Cillis S, Manfredi M, Tota D, Federica M, Passera R, Porpiglia F. Risk of Gleason Score 3+4=7 prostate cancer upgrading at radical prostatectomy is significantly reduced by targeted versus standard biopsy. MINERVA UROL NEFROL 2019; 72:360-368. [PMID: 31619029 DOI: 10.23736/s0393-2249.19.03367-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to evaluate if multiparametric magnetic resonance (mpMRI)-transrectal ultrasound (TRUS) fusion targeted biopsy (TBx) versus untargeted standard biopsy (SBx) may decrease the rate of pathological upgrading of Gleason Score (GS) 3+4 prostate cancer (PCa) at radical prostatectomy (RP). We also evaluated the impact of percent pattern 4 and cribriform glands at biopsy in the risk of GS 3+4=7 upgrading. METHODS A total of 301 patients with GS 3+4 PCa on biopsy (159 SBx and 142 TBx) who underwent laparoscopic robot-assisted RP were sequentially enrolled. Histological data from RP sections were used as reference standard. The concordance of biopsy with pathological GS, as well as the GS 3+4 upgrading at RP were evaluated in different univariate and multivariate binary logistic regression models, testing age, PSA, fPSA%, tumor volume, PI-RADS, clinical stage, percentage of Gleason pattern 4 (GP) and/or presence of cribriform sub-type at biopsy. RESULTS Of the 301 biopsies, the median of GP 4 was 16% of the tissue. Minimal GP 4 (≤16%) cancers had a significant lower median volume (1.7 mL) than those with GP4 >16% (2.9 mL), (P<0.001). Pathological GS 3+4 was confirmed for 58.8% and 82.2% for SBx and TBx patients, respectively. The rate of upgraded and downgraded GS on SBx versus TBx was 38.8% vis. 16.7% and 1.8% and 2.1%, respectively. The rate of upgrading was significantly associated with the presence of GP4 >16% versus ≤16% (OR 4.4, 95% CI 1.4-12.0; P=0.021) and with the presence of cribriform sub-type at biopsy specimens (OR 6.2, 95% CI 2.2-18.7; P<0.001). CONCLUSIONS We demonstrated that TBx technique significantly reduced the risk of GS 3+4 upgrading at RP, compared to SBx one. The rate of upgrading was significantly associated with GP4>16%, mostly when cribriform sub-type was present at biopsy specimens.
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Affiliation(s)
- Stefano De Luca
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Diletta Garrou
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giovanni Cattaneo
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Tota
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massa Federica
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberto Passera
- Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
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5
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Concordance of "Case Level" Global, Highest, and Largest Volume Cancer Grade Group on Needle Biopsy Versus Grade Group on Radical Prostatectomy. Am J Surg Pathol 2019; 42:1522-1529. [PMID: 30080706 DOI: 10.1097/pas.0000000000001137] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The practice of assigning "case level" biopsy Grade Group (GG) or Gleason Score is variable. To our knowledge, a comparison of the concordance of different biopsy "case level" GG with the prostatectomy GG has not been done in a post-2005 prostate cancer cohort. We evaluated the GG in 2527 patients who had biopsy and radical prostatectomy performed at our institution between 2005 and 2014. We compared the agreements, the upgrades, and the downgrades of 3 different "case level" biopsy GG, with the final GG: (1) Global GG (sum of most prevalent and highest Gleason grade in any biopsy part/site-specific specimen); (2) Highest GG (found in any biopsy part/site-specific specimen); and (3) Largest Volume Cancer GG (found in any biopsy part/site-specific specimen). The concordance between the biopsy and the final GG were evaluated using weighted kappa (κ) coefficient. The biopsy Global GG, Highest GG, and Largest Volume Cancer GG were the same as the final GG in 60.4%, 57.1%, and 54.3% cases, respectively (weighted κ values: 0.49, 0.48, and 0.44, respectively). When final GG contained tertiary 5, the overall GG agreement decreased: Global GG 41.5%, Highest GG 40.3%, and Largest Volume Cancer GG 37.1% (weighted κ: 0.22, 0.21, and 0.18, respectively). A subset analysis for cases in which the biopsy Global GG and Highest GG were different (n=180) showed an agreement of 62.4% (weighted κ: 0.37) and 18.8% (weighted κ: 0.16), respectively. In patients without a tertiary Gleason pattern on radical prostatectomy, the Global GG and the Highest GG were identical in 92.4% of biopsies. Assigning a biopsy "case level" Global GG versus using the Highest GG and the Largest Volume Cancer GG resulted in comparable and slightly improved agreement with the final GG in this cohort.
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6
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Predictive Factors and Oncologic Outcome of Downgrade to Pathologic Gleason Score 6⁻7 after Radical Prostatectomy in Patients with Biopsy Gleason Score 8⁻10. J Clin Med 2019; 8:jcm8040438. [PMID: 30935044 PMCID: PMC6518256 DOI: 10.3390/jcm8040438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 01/16/2023] Open
Abstract
Gleason score (GS) 8⁻10 is associated with adverse outcomes in prostate cancer (PCa). However, biopsy GS (bGS) may be upgraded or downgraded post-radical prostatectomy (RP). We aimed to investigate predictive factors and oncologic outcomes of downgrade to pathologic GS (pGS) 6⁻7 after RP in PCa patients with bGSs 8⁻10. We retrospectively reviewed clinical data of patients with bGS ≥ 8 undergoing RP. pGS downgrade was defined as a pGS ≤ 7 from bGS ≥ 8 post-RP. Univariate and multivariate cox regression analysis, logistic regression analysis, and Kaplan⁻Meier curves were used to analyze pGS downgrade and biochemical recurrence (BCR). Of 860 patients, 623 and 237 had bGS 8 and bGS ≥ 9, respectively. Post-RP, 332 patients were downgraded to pGS ≤ 7; of these, 284 and 48 had bGS 8 and bGS ≥ 9, respectively. Prostate-specific antigen (PSA) levels; clinical stage; and adverse pathologic features such as extracapsular extension, seminal vesicle invasion and positive surgical margin were significantly different between patients with pGS ≤ 7 and pGS ≥ 8. Furthermore, bGS 8 (odds ratio (OR): 0.349, p < 0.001), PSA level < 10 ng/mL (OR: 0.634, p = 0.004), and ≤cT3a (OR: 0.400, p < 0.001) were identified as significant predictors of pGS downgrade. pGS downgrade was a significant positive predictor of BCR following RP in patients with high bGS (vs. pGS 8, hazard radio (HR): 1.699, p < 0.001; vs. pGS ≥ 9, HR: 1.765, p < 0.001). In addition, the 5-year BCR-free survival rate in patients with pGS downgrade significantly differed from that in patients with bGS 8 and ≥ 9 (52.9% vs. 40.7%, p < 0.001). Among patients with bGS ≥ 8, those with bGS 8, PSA level < 10 ng/mL, and ≤cT3a may achieve pGS downgrade after RP. These patients may have fewer adverse pathologic features and show a favorable prognosis; thus we suggest that active treatment is needed in these patients. In addition, patients with high-grade bGS should be managed aggressively, even if they show pGS downgrade.
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Delahunt B, Egevad L, Yaxley J, Samaratunga H. The current status of renal cell carcinoma and prostate carcinoma grading. Int Braz J Urol 2018; 44:1057-1062. [PMID: 30516924 PMCID: PMC6442168 DOI: 10.1590/s1677-5538.ibju.2018.06.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand
| | - Lars Egevad
- Department of Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - John Yaxley
- Wesley Hospital, Brisbane, Queensland, Australia
- University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Hemamali Samaratunga
- University of Queensland School of Medicine, Brisbane, Queensland, Australia
- Aquesta Uropathology, Brisbane, Queensland, Australia
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Ramakrishnan VM, Bossert K, Singer G, Lehmann K, Hefermehl LJ. The impact of the 2005 International Society of Urological Pathology Gleason grading consensus on active surveillance for prostate cancer. Cent European J Urol 2018; 70:344-348. [PMID: 29410883 PMCID: PMC5791407 DOI: 10.5173/ceju.2017.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 10/15/2017] [Accepted: 10/20/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Current treatment plans for localized prostate carcinoma (PC) are based on core needle biopsies (CNB) classified using the Gleason score (GS). Recently, many institutions have started using the latest version of International Society of Urological Pathology (ISUP) guideline revision from 2014 for PC grading. Interestingly, this adoption is occurring without first understanding whether the 2005 ISUP revisions had a positive clinical impact. CNB-based GS may underestimate tumor aggressiveness and, therefore, critically impact patient eligibility for active surveillance (AS). The 2005 ISUP recommendations bore a significant impact on the grading of Gleason 6 and 7 PCs - a range that is meaningful for AS. The objective of this study was to compare the concordance between GS in CNB and radical prostatectomy (RP) before and after the 2005 ISUP guideline revisions, with an emphasis on its clinical impact on AS. Material and methods This was a single-center, prospective observational study. CNB were performed in a standardized manner. GS of CNB and RP specimens were compared across three time periods: 1999-2005 (pre-revision), 2006-2007 (transitional period), and 2008-2015 (post-revision). AS is usually employed in patients with GS 6 or GS 7 PC. Thus, we therefore focused on the analysis of patients with CNBs of GS ≤7. Results Between 1999 and 2015, 380 men with GS ≤7 PC underwent RP at our institution (median age: 62y; median PSA: 5.8 ng/ml). Of these, 231 CNB specimens were classified as GS ≤6, while 149 were GS 7.46% (pre-revision), 43% (transitional), and 54% (post-revision) of CNB with original scores ≤6 were later upgraded in corresponding RP specimens (p <0.001). Conclusions The 2005 ISUP GS revisions did not lower the rates of GS upgrades in RP specimens when compared to corresponding initial CNBs. Thus, these revisions did not improve AS selection. Future advances in molecular diagnostics may provide additional valuable information that facilitates patient enrollment in AS programs.
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Affiliation(s)
| | - Karolin Bossert
- Division of Urology, Department of Surgery, Kantonsspital Baden, Switzerland
| | - Gad Singer
- Institute of Pathology, Kantonsspital Baden, Switzerland
| | - Kurt Lehmann
- Division of Urology, Department of Surgery, Kantonsspital Baden, Switzerland
| | - Lukas J Hefermehl
- Division of Urology, Department of Surgery, Kantonsspital Baden, Switzerland
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9
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Rao V, Garudadri G, Shilpa AS, Fonseca D, Sudha SM, Sharma R, Subramanyeshwar TR, Challa S. Validation of the WHO 2016 new Gleason score of prostatic carcinoma. Urol Ann 2018; 10:324-329. [PMID: 30089994 PMCID: PMC6060600 DOI: 10.4103/ua.ua_185_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Context New Gleason Score of Prostate. Aims The aim of this study is to assign the patients with carcinoma prostate into new prognostic grade groups (PGGs) based on revised Gleason score (GS) and follow-up according to the WHO 2016. Subjects and Methods All the biopsies/resected specimens of carcinoma prostate from January 2014 to June 2016 were reviewed, and GS was done according to the WHO 2016. Accordingly, cribriform, fused, and glomeruloid glands were assigned GS 4. Thus, two groups were identified with GS 7 (3 + 4 and 4 + 3). The patients were grouped into PGGs 1-5. The number of patients with change in the prognostic group along with follow-up was calculated. Results There were 143 patients with carcinoma prostate, with a median age of 65 years. The initial GS was revised, and there was a decrease in GS 3 + 4 from 13.9% to 9% and increase in 4 + 3 from 19.6% to 23.8%. There was upgradation of PGG in 11 (7.69%) biopsies; with PGG from 1 to 2 in one; 2to 3 in eight; and 3to 4 in two. Follow-up at 2 years in 22 showed the poor prognoses in the patients who were upgraded to the higher prognostic group. Conclusions A change in PGG according to the WHO 2016 criteria was assigned in 7.69% biopsies of carcinoma prostate, and it correlated with prognosis.
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Affiliation(s)
- Vishal Rao
- Department of Pathology and Lab Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Gowri Garudadri
- Department of Pathology and Lab Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Arya Sahithi Shilpa
- Department of Pathology and Lab Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Daphne Fonseca
- Department of Pathology and Lab Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - S Murthy Sudha
- Department of Pathology and Lab Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rakesh Sharma
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - T Rao Subramanyeshwar
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Sundaram Challa
- Department of Pathology and Lab Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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10
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Pierconti F, Martini M, Cenci T, Petrone GL, Ricci R, Sacco E, Bassi PF, Larocca LM. SOCS3 Immunohistochemical Expression Seems to Support the 2005 and 2014 International Society of Urological Pathology (ISUP) Modified Gleason Grading System. Prostate 2017; 77:597-603. [PMID: 28144985 DOI: 10.1002/pros.23299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND In the 2014, The International Society of Urological Pathology (ISUP) consensus conference update the grading of prostate, last revised in 2005. In this study we evaluate the SOCS3 immunohistochemical protein expression in different Gleason prostatic adenocarcinoma: classical Gleason grade 3, classical Gleason grade 3 upgraded to Gleason grade 4 according to the ISUP modifications and classical and modified Gleason grade 4. The major conclusions were: (i) Cribriform glands should be assigned a Gleason pattern 4, regardless of morphology; (ii) Glomeruloid glands should be assigned a Gleason pattern 4, regardless of morphology; (iii) Grading of mucinous carcinoma of the prostate should be based on its underlying growth pattern rather than all as pattern 4; and (iv) Intraductal carcinoma of the prostate without invasive carcinoma should not assigned Gleason grade and a comment about aggressive carcinoma probably associated should be made. In a recent report we analyzed the methylathion status of cytokine signaling (SOCS) proteins 3 (SOCS3) gene and the consequences of promoter hypermethylation on mRNA and protein expression in a collection of prostate cancer and benign prostate hyperplasia (BPH) and for the first time we demonstrated that a hypermethylation of SOCS3 with a significant reduction of its mRNA and protein expression identifies a subgroup of prostate cancer with a more aggressive behavior. Moreover we demonstrated that the immunohystochemical analysis of SOCS3 protein expression in prostatic cancer biopsies may provide a useful and easier method than SOCS3 methylation analysis to individuate in cancer with intermediate-high grade Gleason score a subgroup of prostate cancer with a more aggressive behavior. METHODS A total of 148 radical prostatectomy with diagnosis of prostatic acinar adenocarcinoma were stratified into three different categories on the basis of Gleason grade: (i) Twenty-six prostatic adenocarcinoma with classical and modified Gleason grade 3; (ii) Fifty seven prostatic adenocarcinoma with classical Gleason grade 3 upgraded to Gleason grade 4 by 2005 and 2014 ISUP Consensus Conference; and (iii) Sixty five prostatic adenocarcinoma with classical and modified Gleason grade 4. Immunohistochemical analysis for SOCS3 was performed and SOCS3 staining intensity were evaluated by two pathologists in three different ways on the basis of the intensity of cytoplasmatic staining: positive (intense cytoplasmatic staining in more than 50% of neoplastic cells) (+), negative (absence of cytoplasmatic staining in more than 50% of neoplastic cells) (-), weakly positive (weak cytoplasmatic staining in more than 50% of neoplastic cells (+/-). RESULTS In the group of prostatic adenocarcinoma Gleason grade 3 we found that SOCS3 positivity (+) were observed in 19 out of 26 cases (73.1%); in 5 out of 26 prostatic adenocarcinoma the neoplastic glands showed weak intensity SOCS3 staining (+/-) (19.2%), while in only two cases we found SOCS-3 negativity (-) (7.7%); in the group of cases with prostatic adenocarcinoma with Gleason grade 4, 16 out 65 cases (24.6%) showed SOCS3 positivity (+); 18 out 65 cases (27.7%) SOCS3 weakly positive (+/-), and in 31 cases (47.7%) SOCS3 negative staining (-) were observed. Interestingly, the group of prostatic adenocarcinoma with histological Gleason 3 pattern upgraded to Gleason 4 pattern according to the 2005 and 2014 ISUP modified grading system, showed SOCS3 positivity (+) in 16 out of 57 cases (28%), in 16 out 57 cases (28%) a weakly positive for SOCS3 (+/-) were observed, while 25 cases (44%) showed negative SOCS3 staining (-). CONCLUSIONS In this study we demonstrated a significant association of SOCS3 positivity (+) with prostatic carcinoma classical Gleason pattern 3 (P < 0.0001), while SOCS3 negative pattern (-) or SOCS3 weakly positive pattern (+/-) were associated to prostatic carcinomas with Gleason pattern 3 upgraded to Gleason pattern 4 (P = 0.0002) and with classical Gleason pattern 4. The significant difference of SOCS3 immunohistochemical expression between classical Gleason grade 3 and Gleason grade 4 upgraded to grade 4 seems to support the definitions and the modifications of Gleason grade 4 of the 2005 and the 2014 International Society of Urological Pathology (ISUP). The hypoexpression of SOCS3 protein in glomeruloid glands could support the hypothesis that from molecular point of view this growth pattern could be different from classical Gleason pattern 3 and biologically more closely to Gleason pattern 4, confirming the conclusions of the 2014 ISUP Conference assigning a Gleason pattern 4 to glomeruloid glands regardless of morphology. Prostate 77: 597-603, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Maurizio Martini
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Tonia Cenci
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Gian Luigi Petrone
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Riccardo Ricci
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of Sacred Heart, Rome, Italy
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11
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Grogan J, Gupta R, Mahon KL, Stricker PD, Haynes AM, Delprado W, Turner J, Horvath LG, Kench JG. Predictive value of the 2014 International Society of Urological Pathology grading system for prostate cancer in patients undergoing radical prostatectomy with long-term follow-up. BJU Int 2017; 120:651-658. [DOI: 10.1111/bju.13857] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Judith Grogan
- Cancer Research Program; Kinghorn Cancer Centre/Garvan Institute of Medical Research; Darlinghurst NSW Australia
| | - Ruta Gupta
- Cancer Research Program; Kinghorn Cancer Centre/Garvan Institute of Medical Research; Darlinghurst NSW Australia
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; University of Sydney; Sydney NSW Australia
| | - Kate L. Mahon
- Cancer Research Program; Kinghorn Cancer Centre/Garvan Institute of Medical Research; Darlinghurst NSW Australia
- Department of Medical Oncology; Chris O'Brien Lifehouse; Camperdown NSW Australia
| | | | - Anne-Maree Haynes
- Cancer Research Program; Kinghorn Cancer Centre/Garvan Institute of Medical Research; Darlinghurst NSW Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology; Sydney NSW Australia
- Australian School of Advanced Medicine; Macquarie University; Sydney NSW Australia
| | - Jennifer Turner
- Douglass Hanly Moir Pathology; Sydney NSW Australia
- Australian School of Advanced Medicine; Macquarie University; Sydney NSW Australia
| | - Lisa G. Horvath
- Cancer Research Program; Kinghorn Cancer Centre/Garvan Institute of Medical Research; Darlinghurst NSW Australia
- Sydney Medical School; University of Sydney; Sydney NSW Australia
- Department of Medical Oncology; Chris O'Brien Lifehouse; Camperdown NSW Australia
| | - James G. Kench
- Cancer Research Program; Kinghorn Cancer Centre/Garvan Institute of Medical Research; Darlinghurst NSW Australia
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; University of Sydney; Sydney NSW Australia
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12
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Athanazio D, Gotto G, Shea-Budgell M, Yilmaz A, Trpkov K. Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade. Histopathology 2017; 70:1098-1106. [DOI: 10.1111/his.13179] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/03/2017] [Accepted: 01/30/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Daniel Athanazio
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
| | - Geoffrey Gotto
- Division of Urology; University of Calgary; Calgary Alberta Canada
| | - Melissa Shea-Budgell
- Cancer Strategic Clinical Network, Research Innovation and Analytics; Alberta Health Services; University of Calgary; Calgary Alberta Canada
- Department of Oncology; University of Calgary; Calgary Alberta Canada
| | - Asli Yilmaz
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
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13
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Yeong J, Sultana R, Teo J, Huang HH, Yuen J, Tan PH, Khor LY. Gleason grade grouping of prostate cancer is of prognostic value in Asian men. J Clin Pathol 2017; 70:745-753. [PMID: 28289065 DOI: 10.1136/jclinpath-2016-204276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/09/2017] [Accepted: 01/25/2017] [Indexed: 11/04/2022]
Abstract
AIM The International Society of Urological Pathology made recommendations for the use of Grade Groups (GG) originally described by Epstein and colleagues over Gleason score (GS) alone in 2014, which was subsequently adopted by the WHO classification in 2016. The majority of studies validating this revision have been in Caucasian populations. We therefore asked whether the new GG system was retrospectively associated with biochemical disease-free survival in a mixed-ethnicity cohort of Asian men. METHODS A total of 680 radical prostatectomies (RPs) from 2005 to 2014 were included. GS from initial biopsy and RP were compared and used to allocate cases to GG, defined as: 1 (GS≤6); 2 (GS 3+4=7); 3 (GS 4+3=7); 4 (GS 4+4=8/5+3=8/3+5=8) and 5 (GS 9-10). Biochemical recurrence was defined as two consecutive post-RP prostate-specific antigen (PSA) levels of >0.2 ng/mL after post-RP PSA reaching the nadir of <0.1 ng/mL. RESULTS Our data showed that Kaplan-Meier analysis revealed significant differences in biochemical recurrence within Gleason GG based on either biopsy or prostatectomy scoring. Multivariate analysis further confirmed that a higher GG was significantly associated with risk of biochemical recurrence. This GG system had a higher prognostic discrimination for both initial biopsy and RP than GS. CONCLUSIONS Our study validates the use of the revised and updated GG system in a mixed-ethnicity population of Asian men. Higher GG was significantly associated with increased risk of biochemical recurrence. We therefore recommend its use to inform clinical management for patients with prostate cancer.
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Affiliation(s)
- Joe Yeong
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Singapore Immunology Network (SIgN), Agency of Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Rehena Sultana
- DUKE-NUS Medical School, Center For Quantitative Medicine, Singapore, Singapore
| | - Jonathan Teo
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - John Yuen
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Li Yan Khor
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
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14
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Alberts AR, Bokhorst LP, Kweldam CF, Schoots IG, van der Kwast TH, van Leenders GJ, Roobol MJ. Biopsy undergrading in men with Gleason score 6 and fatal prostate cancer in the European Randomized study of Screening for Prostate Cancer Rotterdam. Int J Urol 2017; 24:281-286. [DOI: 10.1111/iju.13294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Arnout R Alberts
- Department of Urology; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Leonard P Bokhorst
- Department of Urology; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Charlotte F Kweldam
- Department of Pathology; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Ivo G Schoots
- Department of Radiology; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Theo H van der Kwast
- Department of Pathology; Princess Margaret Cancer Center; University Health Network; Toronto Ontario Canada
| | - Geert J van Leenders
- Department of Pathology; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Monique J Roobol
- Department of Urology; Erasmus University Medical Center; Rotterdam the Netherlands
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15
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Leapman MS, Cowan JE, Simko J, Roberge G, Stohr BA, Carroll PR, Cooperberg MR. Application of a Prognostic Gleason Grade Grouping System to Assess Distant Prostate Cancer Outcomes. Eur Urol 2016; 71:750-759. [PMID: 27940155 DOI: 10.1016/j.eururo.2016.11.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is growing enthusiasm for the adoption of a novel grade grouping system to better represent Gleason scores. OBJECTIVE To evaluate the ability of prognostic Gleason grade groups to predict prostate cancer (PCa)-specific mortality (PCSM) and bone metastatic progression. DESIGN, SETTING, AND PARTICIPANTS We identified patients with PCa enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry across treatment strategies, including conservative and nondefinitive therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We examined the prognostic ability of Gleason grade groups to predict risk of PCSM and bone metastasis using the Kaplan-Meier method and unadjusted and adjusted Cox proportional hazards models. RESULTS AND LIMITATIONS We identified 10529 men with PCa followed for a median of 81 mo (interquartile range 40-127), including 64% in group I (< 3 + 4); 17% in group II (3+4); 9% in group III (4+3); 6% in group IV (4+4); and 4% in group V (≥ 4 + 5). Relative to grade group I, the unadjusted risks of PCSM and bone metastasis were significantly associated with prognostic grade groupings for both biopsy and prostatectomy samples (all p<0.01). Pairwise comparisons within Gleason sums collapsed within grade group V were not significant; however, this analysis was limited by a small representation of men with Gleason pattern ≥ 4 + 5. CONCLUSIONS The prognostic grade grouping system is associated with risk of PCSM and metastasis across management strategies, including definitive therapy, conservative management, and primary androgen deprivation. PATIENT SUMMARY A five-level reporting system for prostate cancer pathology is associated with the risk of late prostate cancer endpoints.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
| | - Janet E Cowan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Jeffry Simko
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Gray Roberge
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Bradley A Stohr
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Peter R Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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16
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Ham WS, Chalfin HJ, Feng Z, Trock BJ, Epstein JI, Cheung C, Humphreys E, Partin AW, Han M. New Prostate Cancer Grading System Predicts Long-term Survival Following Surgery for Gleason Score 8-10 Prostate Cancer. Eur Urol 2016; 71:907-912. [PMID: 27876305 DOI: 10.1016/j.eururo.2016.11.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 11/04/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The newly proposed five-tiered prostate cancer grading system (PCGS) divides Gleason score (GS) 8-10 disease into GS 8 and GS 9-10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes. OBJECTIVE To assess the significance of distinguishing GS 8 versus 9-10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS. DESIGN, SETTING, AND PARTICIPANTS Of 23918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8-10, and 1047 men with RP GS 8-10. OUTCOME MEASURES AND STATISTICAL ANALYSIS Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9-10. We compared all-cause mortality (ACM) and prostate cancer-specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event. RESULTS AND LIMITATIONS Compared to men with GS 8, men with GS 9-10 had later RP year and higher pathologic stage. Among men with Bx GS 8-10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1-7) for both overall and cancer-specific survival. Of men with RP GS 8-10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2-8) and 4 yr (IQR 2-9) for overall and cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9-10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37-3.30; p<0.01) and RP GS (HR 2.38, 95% CI 1.74-3.28; p<0.01). This association persisted in multivariable models after adjusting for perioperative variables. CONCLUSIONS Men with GS 9-10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9-10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS. PATIENT SUMMARY The prostate cancer grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason score 8-10 disease based on both biopsy and RP Gleason scores. There are significant differences in all-cause mortality and prostate cancer-specific mortality following surgery between men with Gleason score 8 and those with Gleason score 9-10 disease.
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Affiliation(s)
- Won Sik Ham
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heather J Chalfin
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Zhaoyong Feng
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bruce J Trock
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jonathan I Epstein
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Carling Cheung
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Elizabeth Humphreys
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alan W Partin
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Misop Han
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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17
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The Impact of Downgrading from Biopsy Gleason 7 to Prostatectomy Gleason 6 on Biochemical Recurrence and Prostate Cancer Specific Mortality. J Urol 2016; 197:1060-1067. [PMID: 27847296 DOI: 10.1016/j.juro.2016.11.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Gleason score is one of the most important prognostic indicators for prostate cancer. Downgrading from biopsy Gleason score 7 to radical prostatectomy Gleason score 6 occurs commonly and yet to our knowledge the impact on survival outcomes is unknown. We examined biochemical recurrence and prostate cancer specific mortality risk in a large cohort evaluated by a single group of expert urological pathologists. MATERIALS AND METHODS Of 23,918 men who underwent radical prostatectomy at our institution between 1984 and 2014, 10,236 with biopsy and radical prostatectomy Gleason score 6 or 7 without upgrading were included in analysis. The cohort was divided into 3 groups, including group 1-biopsy and radical prostatectomy Gleason score 6 in 6,923 patients (67.6%), group 2-Gleason score 7 downgraded to radical prostatectomy Gleason score 6 in 648 (6.3%) and group 3-biopsy and radical prostatectomy Gleason score 7 in 2,665 (26.0%). Biochemical recurrence and prostate cancer specific mortality risks were compared using Cox regression and competing risk analyses adjusting for clinicopathological variables. RESULTS At a median followup of 5 years (range 1 to 29), 992 men experienced biochemical recurrence and 95 had died of prostate cancer. Biochemical recurrence-free survival in downgraded cases (group 2) was better than in group 3 cases, which had Gleason score 7 on biopsy and radical prostatectomy (p <0.001), but worse than group 1 cases, which had Gleason score 6 on biopsy and radical prostatectomy (p <0.001). Downgrading was independently associated with biochemical recurrence (adjusted HR 1.87, p <0.0001) but not with prostate cancer specific mortality (adjusted HR 1.65, p = 0.636). CONCLUSIONS Downgrading from biopsy Gleason score 7 to radical prostatectomy Gleason score 6 was an independent predictor of biochemical recurrence but not prostate cancer specific mortality, likely due to the presence of minor amounts of Gleason pattern 4.
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18
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Diolombi ML, Epstein JI. Metastatic potential to regional lymph nodes with Gleason score ≤7, including tertiary pattern 5, at radical prostatectomy. BJU Int 2016; 119:872-878. [DOI: 10.1111/bju.13623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mairo L. Diolombi
- Department of Pathology; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Jonathan I. Epstein
- Department of Pathology; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Urology; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Oncology; Johns Hopkins Medical Institutions; Baltimore MD USA
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19
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The prognostic significance of the 2014 International Society of Urological Pathology (ISUP) grading system for prostate cancer. Pathology 2016; 47:515-9. [PMID: 26325670 DOI: 10.1097/pat.0000000000000315] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 2005 International Society of Urological Pathology (ISUP) modified Gleason grading system was further amended in 2014 with the establishment of grade groupings (ISUP grading). This study examined the predictive value of ISUP grading, comparing results with recognised prognostic parameters.Of 3700 men undergoing radical prostatectomy (RP) reported at Aquesta Pathology between 2008 and 2013, 2079 also had a positive needle biopsy available for review. We examined the association between needle biopsy 2014 ISUP grade and 2005 modified Gleason score, tumour volume, pathological stage of the subsequent RP tumour, as well as biochemical recurrence-free survival (BRFS). The median age was 62 (range 32-79 years). Median serum prostate specific antigen was 5.9 (range 0.4-69 ng/mL). For needle biopsies, 280 (13.5%), 1031 (49.6%), 366 (17.6%), 77 (3.7%) and 325 (15.6%) were 2014 ISUP grades 1-5, respectively. Needle biopsy 2014 ISUP grade showed a significant association with RP tumour volume (p < 0.001), TNM pT and N stage (p < 0.001) and BRFS (p < 0.001). Multivariate analysis using Cox proportional hazards regression model showed serum prostate specific antigen (PSA) at the time of diagnosis and ISUP grade >2 to be significantly associated with BRFS.This study provides evidence of the prognostic significance of ISUP grading for thin core needle biopsy of prostate.
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20
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Samaratunga H, Delahunt B, Yaxley J, Srigley JR, Egevad L. From Gleason to International Society of Urological Pathology (ISUP) grading of prostate cancer. Scand J Urol 2016; 50:325-9. [PMID: 27415753 DOI: 10.1080/21681805.2016.1201858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gleason grading of prostate cancer has gained worldwide acceptance since its introduction 50 years ago. This system has fulfilled the role of a powerful prognostic indicator for many years and this has influenced treatment. There have been numerous changes to the management and diagnosis of prostate cancer since 1966, including prostate-specific antigen screening, resulting in the early detection of prostate cancer, This has resulted in the evolution of Gleason grading with the informal adoption of a number of alterations. Significant changes to Gleason grading were made in 2005 through a consensus conference convened by the International Society of Urological Pathology (ISUP). In more recent times, the necessity for further changes to prostate cancer grading has been apparent and a follow-up ISUP consensus conference was held in 2014. Changes resulting from this conference included the classifying of all cribriform cancer and glomeruloid patterns as Gleason grade 4, the grading of mucinous adenocarcinoma based on underlying architecture rather than uniformly considering these tumors as pattern 4, and the introduction of a Gleason score (GS)-based 5 grade system, which incorporated the 2014 modifications to the Gleason grading system. Designated ISUP grade, this system consists of five grades: grade 1 (GS ≤3 + 3), grade 2 (GS 3 + 4), grade 3 (GS 4 + 3), grade 4 (GS 4 + 4, 3 + 5, 5 + 3) and grade 5 (GS 9-10). With further advances recently reported in the literature, it is apparent that amendments to the current system are likely to be necessary in the future.
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Affiliation(s)
- Hemamali Samaratunga
- a Aquesta Pathology , Brisbane , Queensland , Australia ;,b University of Queensland School of Medicine , Brisbane , Queensland , Australia
| | - Brett Delahunt
- a Aquesta Pathology , Brisbane , Queensland , Australia ;,c Department of Pathology and Molecular Medicine , Wellington School of Medicine and Health Sciences, University of Otago , Wellington , New Zealand
| | - John Yaxley
- b University of Queensland School of Medicine , Brisbane , Queensland , Australia ;,d Department of Urology , Royal Brisbane Hospital , Brisbane , Queensland , Australia
| | - John R Srigley
- e Department of Pathology and Molecular Medicine , McMaster University , Hamilton , Ontario , Canada
| | - Lars Egevad
- f Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden ;,g Department of Pathology , Karolinska University Hospital , Stockholm , Sweden
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21
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Danneman D, Drevin L, Delahunt B, Samaratunga H, Robinson D, Bratt O, Loeb S, Stattin P, Egevad L. Accuracy of prostate biopsies for predicting Gleason score in radical prostatectomy specimens: nationwide trends 2000-2012. BJU Int 2016; 119:50-56. [DOI: 10.1111/bju.13458] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Daniela Danneman
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
| | - Linda Drevin
- Regional Cancer Centre; Uppsala University Hospital; Uppsala Sweden
| | - Brett Delahunt
- Wellington School of Medicine and Health Sciences; University of Otago; Wellington New Zealand
| | - Hemamali Samaratunga
- Aquesta Pathology; Brisbane Qld Australia
- The University of Queensland School of Medicine; Brisbane Qld Australia
| | - David Robinson
- Department of Urology; Ryhov County Hospital; Jönköping Sweden
| | - Ola Bratt
- Department of Urology; Cambridge University Hospitals; Cambridge UK
- Department of Translational Medicine; Lund University; Lund Sweden
| | - Stacy Loeb
- Department of Urology and Population Health; New York University and Manhattan Veterans Affairs Medical Centre; New York NY USA
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences; Urology and Andrology; Umeå University; Umeå Sweden
- Department of Surgical Sciences; Uppsala University; Uppsala Umeå Sweden
| | - Lars Egevad
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
- Department of Pathology; Karolinska University Hospital; Stockholm Sweden
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22
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Gordetsky J, Epstein J. Grading of prostatic adenocarcinoma: current state and prognostic implications. Diagn Pathol 2016; 11:25. [PMID: 26956509 PMCID: PMC4784293 DOI: 10.1186/s13000-016-0478-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/26/2016] [Indexed: 12/21/2022] Open
Abstract
Background Despite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient’s prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care. Main Body We describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10. Conclusion As this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.
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Affiliation(s)
- Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jonathan Epstein
- Department of Pathology, The Johns Hopkins Hospital, The Weinberg Building Room 2242. 401 North Broadway St., Baltimore, MD, 21231, USA. .,Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Chen N, Zhou Q. The evolving Gleason grading system. Chin J Cancer Res 2016; 28:58-64. [PMID: 27041927 PMCID: PMC4779758 DOI: 10.3978/j.issn.1000-9604.2016.02.04] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology (ISUP) in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new "Grade Group" system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.
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Affiliation(s)
- Ni Chen
- Pathology Department, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China
| | - Qiao Zhou
- Pathology Department, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China
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Clinical Validation of the 2005 ISUP Gleason Grading System in a Cohort of Intermediate and High Risk Men Undergoing Radical Prostatectomy. PLoS One 2016; 11:e0146189. [PMID: 26731672 PMCID: PMC4712132 DOI: 10.1371/journal.pone.0146189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022] Open
Abstract
In 2005, the International Society of Urological Pathology (ISUP) introduced several modifications to the original Gleason system that were intended to enhance the prognostic power of Gleason score (GS). The objective of this study was to clinically validate the 2005 ISUP Gleason grading system for its ability to detect metastasis. We queried our institutional RP database for men with NCCN clinically localized intermediate to high-risk disease undergoing radical prostatectomy (RP) between 1992 and 2010 with no additional treatment until the time of metastatic progression. A case-cohort design was utilized. A total of 333 available RP samples were re-reviewed and GS was reassigned per the 2005 ISUP Gleason system. Cumulative incidence of metastasis was 0%, 8.4%, 24.5% and 44.4% among specimens that were downgraded, unchanged, had one point GS increase and two point GS increase, respectively. The hazard ratio for metastasis raised in GS 8 and 9 compared to GS 7 from 2.77 and 5.91 to 3.49 and 9.31, respectively. The survival c-index of GS increased from 0.70 to 0.80 when samples were re-graded at 5 years post RP. The c-index of the reassigned GS was higher than the original GS (0.77 vs 0.64) for predicting PCSM at 10 years post RP. The regraded GS improved the prediction of metastasis and PCSM. This validates the updated Gleason grading system using an unambiguous clinical endpoint and highlights the need for reassignment of Gleason grading according to 2005 ISUP system when considering comparisons of novel biomarkers to clinicopathological variables in archival cohorts.
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Kır G, Seneldir H, Gumus E. Outcomes of Gleason score 3 + 4 = 7 prostate cancer with minimal amounts (<6%) vs ≥6% of Gleason pattern 4 tissue in needle biopsy specimens. Ann Diagn Pathol 2015; 20:48-51. [PMID: 26750655 DOI: 10.1016/j.anndiagpath.2015.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The International Society of Urological Pathology Gleason grading system was modified in 2005. Since the modified system was introduced, many cancers that previously would have been categorized as Gleason score (GS) 6 are now categorized as GS 7 based on biopsy specimens that only contain minimal amounts (<6%) of Gleason pattern (GP) 4 tissue. However, the clinical significance of observing <6% of GP 4 tissue in biopsies of GS 7 prostate cancer has not been studied. MATERIAL AND METHODS This study was based on needle biopsy specimens that were categorized as GS 6 or GS 7 and were obtained from patients who underwent radical prostatectomy (RP) with available follow-up data. We assessed the quantity of GP 4 tissue in biopsy specimens of GS 7 prostate cancer. Further, we evaluated the correlation between the quantity of GP 4 tissue and disease progression after RP. RESULTS GP 4 comprising 26-49% of the specimen, GS 4+3 and percentage of total core tissue scored as positive were significant and independent predictors of prostate-specific antigen (PSA) failure after RP, as assessed using a multivariate Cox regression model that included the quantity of GP 4 in the prostate biopsy specimen, preoperative PSA, perineural invasion, clinical stage, number of positive cores, and percentage of core tissue scored as positive. Cases with GS 3+3 and cases in which the observed GP 4 area was <6% did not differ significantly in terms of biochemical PSA recurrence (BPR) status. In contrast, cases with 6-25% GP 4 tissue, 26-49% GP 4 tissue, and GS 4+3 showed more frequent BPR than cases with GS 3+3. CONCLUSIONS Our data suggest that the quantity of GP 4 tissue in GS 7 cancer has clinical significance. However, there is a need for larger studies of the clinical significance of biopsy specimens that include <6% GP 4 tissue. We should reconsider whether the amount of GP 4 should be included in standart pathology reports.
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Affiliation(s)
- Gozde Kır
- Umraniye Education & Research Hospital, Istanbul, Turkey.
| | | | - Eyup Gumus
- Umraniye Education & Research Hospital, Istanbul, Turkey.
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Adeniran AJ, Humphrey PA. Morphologic Updates in Prostate Pathology. Surg Pathol Clin 2015; 8:539-60. [PMID: 26612214 DOI: 10.1016/j.path.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the past several years, modifications have been made to the original Gleason system with resultant therapeutic and prognostic implications. Several morphologic variants of prostatic adenocarcinoma have also been described. Prostate pathology has also evolved over the years with the discovery and utility of new immunohistochemical stains. The topics discussed in this update include the Gleason grading system, prognostic grade grouping, variants of prostatic adenocarcinoma, and the application of immunohistochemistry to prostate pathology.
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Affiliation(s)
- Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, LH 108, New Haven, CT 06520, USA.
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, LH 108, New Haven, CT 06520, USA
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Helpap B, Ringli D, Tonhauser J, Poser I, Breul J, Gevensleben H, Seifert HH. The Significance of Accurate Determination of Gleason Score for Therapeutic Options and Prognosis of Prostate Cancer. Pathol Oncol Res 2015; 22:349-56. [PMID: 26563277 DOI: 10.1007/s12253-015-0013-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022]
Abstract
The Gleason score (GS) to date remains one of the most reliable prognostic predictors in prostate cancer (PCa). However, the majority of studies supporting its prognostic relevance were performed prior to its modification by the International Society of Urological Pathology (ISUP) in 2005. Furthermore, the combination of Gleason grading and nuclear/nucleolar subgrading (Helpap score) has been shown to essentially improve grading concordance between biopsy and radical prostatectomy (RP) specimens. This prompted us to investigate the modified GS and combigrading (Gleason/Helpap score) in association with clinicopathological features, biochemical recurrence (BCR), and survival. Core needle biopsies and corresponding RP specimens from 580 patients diagnosed with PCa between 2005 and 2010 were evaluated. According to the modified GS, the comparison between biopsy and RP samples resulted in an upgrading from GS 6 to GS 7a and GS 7b in 65% and 19%, respectively. Combigrading further resulted in an upgrading from low grade (GS 6/2a) to intermediate grade PCa (GS 6/2b) in 11.1% and from intermediate grade (GS 6/2b) to high grade PCa (GS 7b/2b) in 22.6%. Overall, well-differentiated PCa (GS 6/2a) was detected in 2.8% of RP specimens, while intermediate grade (GS 6/2b and GS 7a/2b) and high grade cancers (≥ GS 7b) accounted for 39.5% and 57.4% of cases, respectively. At a mean follow-up of 3.9 years, BCR was observed in 17.6% of patients with intermediate (9.8%) or high grade PCa (30.2%), while PSA relapse did not occur in GS 6/2a PCa. In conclusion, adding nuclear/nucleolar subgrading to the modified GS allowed for a more accurate distinction between low and intermediate grade PCa, therefore offering a valuable tool for the identification of patients eligible for active surveillance (AS).
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Affiliation(s)
- Burkhard Helpap
- Department of Pathology, Hegau-Bodensee Hospital of Singen, PO Box 720, 78207, Singen, Germany.
| | - Daniel Ringli
- Department of Pathology, Hegau-Bodensee Hospital of Singen, PO Box 720, 78207, Singen, Germany
| | - Jens Tonhauser
- Department of Urology, Hegau-Bodensee Hospital of Singen, Singen, Germany
| | - Immanuel Poser
- Department of Urology and Urologic Oncology, Loretto Hospital, Freiburg, Germany
| | - Jürgen Breul
- Department of Urology and Urologic Oncology, Loretto Hospital, Freiburg, Germany
| | | | - Hans-Helge Seifert
- Department of Urology, Hegau-Bodensee Hospital of Singen, Singen, Germany
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Prostate Biopsy and Radical Prostatectomy Gleason Score Correlation in Heterogenous Tumors. Am J Surg Pathol 2015; 39:1213-8. [DOI: 10.1097/pas.0000000000000499] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Danneman D, Drevin L, Robinson D, Stattin P, Egevad L. Gleason inflation 1998-2011: a registry study of 97,168 men. BJU Int 2015; 115:248-55. [PMID: 24552193 DOI: 10.1111/bju.12671] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study long-term trends in Gleason grading in a nationwide population and to assess the impact of the International Society of Urological Pathology (ISUP) revision in 2005 of the Gleason system on grading practices, as in recent years there has been a shift upwards in Gleason grading of prostate cancer. PATIENTS AND METHODS All newly diagnosed prostate cancers in Sweden are reported to the National Prostate Cancer Register (NPCR). In 97 168 men with a primary diagnosis of prostate cancer on needle biopsy from 1998 to 2011, Gleason score, clinical T stage (cT) and serum levels of prostate-specific antigen (s-PSA) at diagnosis were analysed. RESULTS Gleason score, cT stage and s-PSA were reported to the NPCR in 97%, 99% and 99% of cases. Before and after 2005, Gleason score 7-10 was diagnosed in 52% and 57%, respectively (P < 0.001). After standardisation for cT stage and s-PSA with 1998 as baseline these tumours increased from 59% to 72%. Among low-risk tumours (stage cT1 and s-PSA 4-10 ng/mL) Gleason score 7-10 increased from 16% in 1998 to 40% in 2011 (P trend < 0.001), mean 19% and 33% before and after 2005 (P < 0.001). Among high-risk tumours (stage T3 and s-PSA 20-50 ng/mL) Gleason score 7-10 increased from 65% in 1998 to 94% in 2011 (P trend < 0.001), mean 78% and 90% before and after 2005 (P < 0.001). A Gleason score of 2-5 was reported in 27% in 1998 and 1% in 2011. Gleason score 5 decreased sharply after 2005 and Gleason score 2-4 was almost abandoned. CONCLUSIONS There has been a gradual shift towards higher Gleason grading, which started before 2005 but became more evident after the ISUP 2005 revision. Among low-stage tumours reporting of Gleason score 7-10 was more than doubled during the study period. When corrected for stage migration upgrading is considerable over recent decades. This has clinical consequences for therapy decisions such as eligibility for active surveillance. Grading systems need to be as stable as possible to enable comparisons over time and to facilitate the interpretation of the prognostic impact of grade.
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Affiliation(s)
- Daniela Danneman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Uppsala University Hospital, Uppsala, Sweden
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30
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Muezzinoglu B, Yorukoglu K. Current practice in handling and reporting prostate needle biopsies: results of a Turkish survey. Pathol Res Pract 2015; 211:374-80. [PMID: 25701362 DOI: 10.1016/j.prp.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 01/06/2015] [Accepted: 01/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2005 ISUP (International Society of Urological Pathology) consensus revised the Gleason grading system. METHOD We conducted a web based national survey of the members of Uropathology Working Group (WG) and general pathologists (NWP) to investigate the current practice in reporting prostate needle biopsies. RESULTS The revised system was well known and applied by the respondents. In pattern analysis major difference was detected in reporting medium sized, regular cribriform glands. In both group this pattern was reported as Gleason Pattern (GP) 3 by at least 50% of the repliers, the rest reported this pattern as GP 4. Gleason Score (GS) 2-4 was not reported by the WG. In NWP GS 2-4 was reported by 25% either frequently of infrequently. Any amount of secondary higher grade was included in GS by 92.5% of WG and 70% of NWP (p<0.05). Five percent cut off was requested for the lower secondary grade by 71.4% of WG but 64% of NWP. (p<0.05) Tertiary pattern was reported by 64.5% of WG and 34% of NWP (p<0.05). Individual GS was assigned for each core by 46.4% of WG and 26.5% of NWP (p<0.05). When measuring the extend of cancer, most included the benign tissue between cancer foci in the same core. Fat invasion was interpreted as extraprostatic invasion by 85.7% of WG and 55.9%of NWP (p<0.05). CONCLUSION This study showed the specific points where the educational efforts should be focused to have a better and standardized practice pattern of pathologists when reporting prostate biopsies.
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Affiliation(s)
- Bahar Muezzinoglu
- Kocaeli University Medical School, Department of Pathology, Kocaeli, Turkey.
| | - Kutsal Yorukoglu
- Dokuz Eylul University Medical School, Department of Pathology, İzmir, Turkey
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Oxley J, Simpkin A, Goepel J, Varma M, Griffiths D, Grigor K, Mayer N, Warren A, Deshmukh N, Bhattarai S, Dormer J, Hounsome L, Adamczyk LA, Metcalfe C, Lane JA, Davis M, Donovan JL, Neal DE, Hamdy FC, Robinson MC. Gleason drift in the NIHR ProtecT study. Histopathology 2015; 66:438-46. [PMID: 25231130 DOI: 10.1111/his.12549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 09/11/2014] [Indexed: 11/30/2022]
Abstract
AIMS There is increasing evidence of Gleason score (GS) drift in prostatic core biopsies during the last two decades. The ProtecT study is a randomized controlled study and provides an excellent cohort to study the effect of time, prostate-specific antigen (PSA) level, perineural invasion, tumour length and age on GS. METHODS AND RESULTS The ProtecT study recruited men in the United Kingdom between 1999 and 2010. The Gleason scores were grouped into four categories ≤ 3 + 3, 3 + 4, 4 + 3 and ≥ 4 + 4 for analysis. Data from England between 2000 and 2012 were also available. A total of 3282 biopsies containing cancer were analysed. For each year of the ProtecT study, the odds of being diagnosed with a higher GS category increased by 4.9%. Higher GS was also associated with perineural invasion, increasing tumour length, age and PSA level. While biopsy GS from England was incomplete, it also showed a marked decrease in GS five and six tumours during the same period. CONCLUSION There was GS drift from 3 + 3 to 3 + 4 with time in the ProtecT study, but there appeared to be no significant change in percentage of GS 4 + 3 or higher. This drift was less dramatic when compared to GS in the rest of England.
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Affiliation(s)
- Jon Oxley
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
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Biesterfeld S. [Documentation quality of histopathology reports of prostate needle biopsies: a snapshot]. Urologe A 2014; 53:1644-50. [PMID: 25272987 DOI: 10.1007/s00120-014-3584-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A standardized assessment of findings from prostate needle biopsies in pathology is of great importance for the individual recommendations for therapy of patients with prostate cancer. To this end criteria were developed which are formulated as recommendations in the S3 guidelines for prostate cancer and in joint instructions of the Bundesverband Deutscher Pathologen (BDP, "National Association of German Pathologists") and the Deutsche Gesellschaft für Pathologie (DGP, "German Society of Pathology"). In this article the findings from tumor positive prostate needle biopsies taken from various institutes in Germany, were investigated exclusively to determine to what extent the recommended parameters were followed. MATERIAL AND METHODS The study encompassed the findings from 91 patients with a mean age of 65.3 years from whom an average of 9.3 biopsy samples from different regions of the prostate were submitted. All diagnosed tumors corresponded to a standard type adenocarcinoma according to the classification of the World Health Organization (WHO) which was detected in an average of 2.5 biopsy regions per patient. The assessment was made from H & E stained serial sections which was supplemented in 11 (12.1%) cases by special staining methods and in 40 (44%) cases by immunohistochemical staining techniques. The length of the needle biopsy was documented in 88 (96.7%) cases and the tumor spread also in 88 cases. The tumor stage was reported in 16 cases (17.6%). RESULTS The Gleason grading score (GS) was reported in all 91 cases whereby the old GS was explicitly used in 1 case and the modified GS in all other cases. The allocated GS ranged from 4 to 10 whereby 8 cases were graded as ≤5, 46 as GS grade 6, 27 as GS grade 7 and 10 as GS >7. Out of 45 cases with several positive biopsy samples, 38 were uniformly graded (84.4%), 6 out of the 7 samples which were not uniformly graded were allocated a GS of 6 or 7 and 1 sample was graded as GS 6-9. In 64 cases (70.3%) the conventional 3-stage WHO grading (n=42) and the Helpap grading (n=22) were additionally used. The WHO and Helpap grading scores were found to be highly correlated with the GS grading scores and the Union for International Cancer Control (UICC) grading scores derived from it (χ²-test, p<0.001), although surprising allocations were selected in isolated cases. CONCLUSION In total, the only serious deficits were that in three cases (3.3%) no information was supplied on the estimated spread of the tumor in the tumor positive biopsies because this information can be decisive for therapy decisions, particularly for the selection of an active surveillance strategy. Also a relatively large number of cases were assigned a GS score ≤ 5 which is not recommended in the modified Gleason grading. Furthermore, translation of the GS into the other grading forms used revealed that the biological assessment of the GS showed clear differences between the various participating institutes. In conclusion, the findings of the pathologists as a rule incorporated all the parameters necessary for a therapy decision in accordance with the guidelines so that they can be considered comprehensive and completely valid apart from a few exceptions.
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Affiliation(s)
- S Biesterfeld
- Zentrum für Pathologie, Schwerpunkt Cytopathologie, Universitätsklinikum der Heinrich Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland,
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Prognostic histopathological and molecular markers on prostate cancer needle-biopsies: a review. BIOMED RESEARCH INTERNATIONAL 2014; 2014:341324. [PMID: 25243131 PMCID: PMC4163394 DOI: 10.1155/2014/341324] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/04/2014] [Indexed: 12/16/2022]
Abstract
Prostate cancer is diverse in clinical presentation, histopathological tumor growth patterns, and survival. Therefore, individual assessment of a tumor's aggressive potential is crucial for clinical decision-making in men with prostate cancer. To date a large number of prognostic markers for prostate cancer have been described, most of them based on radical prostatectomy specimens. However, in order to affect clinical decision-making, validation of respective markers in pretreatment diagnostic needle-biopsies is essential. Here, we discuss established and promising histopathological and molecular parameters in diagnostic needle-biopsies.
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Lucia MS, Bostwick DG, Somerville MC, Fowler IL, Rittmaster RS. Comparison of Classic and International Society of Urological Pathology 2005 Modified Gleason Grading Using Needle Biopsies From the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) Trial. Arch Pathol Lab Med 2013; 137:1740-6. [DOI: 10.5858/arpa.2012-0447-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Use of the International Society of Urological Pathology (ISUP) 2005 modified Gleason score may result in higher scores compared with the classic Gleason scoring system.
Objective.—To compare scores derived using the 2 scoring systems.
Design.—On-study and for-cause biopsies were centrally reviewed and assigned a classic Gleason score in the Reduction by Dutasteride of prostate Cancer Events trial. Positive biopsies were reviewed by an independent pathologist in a secondary review using the ISUP 2005 modified Gleason score. The independent pathologist also recorded a classic Gleason score.
Results.—In total, 1482/1507 (98%) positive biopsy results were independently reviewed. Scores assigned by the 2 pathologists (classic versus modified) agreed in 83% (1230 of 1481) of cases; 99% (1471 of 1481) of cancers were within ±1 of their previous score. Of discordant cases, similar numbers of biopsies were upgraded and downgraded in the secondary review, with minor differences in the score distributions. Interobserver agreement was good, with κ values ranging from 0.62 (95% confidence interval [CI], 0.56–0.67) to 0.70 (95% CI, 0.65–0.76). The overall number of high-grade tumors (Gleason score 8–10; n = 48) remained constant between reviews, with 3 fewer cases in the placebo group (n = 16) and 3 more in the dutasteride group (n = 32) in the secondary review. When comparing the independent pathologist's modified scores versus the classic, 17 of 1481 cancers (1.1%) were upgraded (including 9 of 17 upgrades [53%] to high-grade tumors).
Conclusions.—This analysis showed similar score distributions between the classic and modified Gleason scoring systems. The differences seen between the 2 pathologists' scores likely reflect differences in interpretation rather than the scoring system chosen.
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Affiliation(s)
- M. Scott Lucia
- From the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Lucia); Bostwick Laboratories, Richmond, Virginia (Dr Bostwick); and GlaxoSmithKline, Research Triangle Park, North Carolina (Mr Somerville, Ms Fowler, and Dr Rittmaster). Ms Fowler is with Pharmaceutical Product Development, 929 North Front St, Wilmington, North Carolina. Dr Rittmaster is now at 42 William Glen Dr, Camden, Maine
| | - David G. Bostwick
- From the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Lucia); Bostwick Laboratories, Richmond, Virginia (Dr Bostwick); and GlaxoSmithKline, Research Triangle Park, North Carolina (Mr Somerville, Ms Fowler, and Dr Rittmaster). Ms Fowler is with Pharmaceutical Product Development, 929 North Front St, Wilmington, North Carolina. Dr Rittmaster is now at 42 William Glen Dr, Camden, Maine
| | - Matthew C. Somerville
- From the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Lucia); Bostwick Laboratories, Richmond, Virginia (Dr Bostwick); and GlaxoSmithKline, Research Triangle Park, North Carolina (Mr Somerville, Ms Fowler, and Dr Rittmaster). Ms Fowler is with Pharmaceutical Product Development, 929 North Front St, Wilmington, North Carolina. Dr Rittmaster is now at 42 William Glen Dr, Camden, Maine
| | - Ivy L. Fowler
- From the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Lucia); Bostwick Laboratories, Richmond, Virginia (Dr Bostwick); and GlaxoSmithKline, Research Triangle Park, North Carolina (Mr Somerville, Ms Fowler, and Dr Rittmaster). Ms Fowler is with Pharmaceutical Product Development, 929 North Front St, Wilmington, North Carolina. Dr Rittmaster is now at 42 William Glen Dr, Camden, Maine
| | - Roger S. Rittmaster
- From the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Lucia); Bostwick Laboratories, Richmond, Virginia (Dr Bostwick); and GlaxoSmithKline, Research Triangle Park, North Carolina (Mr Somerville, Ms Fowler, and Dr Rittmaster). Ms Fowler is with Pharmaceutical Product Development, 929 North Front St, Wilmington, North Carolina. Dr Rittmaster is now at 42 William Glen Dr, Camden, Maine
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Sfoungaristos S, Katafigiotis I, Perimenis P. The role of PSA density to predict a pathological tumour upgrade between needle biopsy and radical prostatectomy for low risk clinical prostate cancer in the modified Gleason system era. Can Urol Assoc J 2013; 7:E722-7. [PMID: 24282465 DOI: 10.5489/cuaj.374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We evaluate the role of prostate-specific antigen (PSA) density to predict Gleason score upgrade between prostate biopsy material and radical prostatectomy specimen examination in patients with low-risk prostate cancer. METHODS Between January 2007 and November 2011, 133 low-risk patients underwent a radical prostatectomy. Using the modified Gleason criteria, tumour grade of the surgical specimens was examined and compared to the biopsy results. RESULTS A tumour upgrade was noticed in 57 (42.9%) patients. Organ-confined disease was found in 110 (82.7%) patients, while extracapsular disease and seminal vesicles invasion was found in 19 (14.3%) and 4 (3.0%) patients, respectively. Positive surgical margins were reported in 23 (17.3%) patients. A statistical significant correlation between the preoperative PSA density value and postoperative upgrade was found (p = 0.001) and this observation had a predictive value (p = 0.002); this is in contrast to the other studied parameters which failed to reach significance, including PSA, percentage of cancer in biopsy and number of biopsy cores. Tumour upgrade was also highly associated with extracapsular cancer extension (p = 0.017) and the presence of positive surgical margins (p = 0.017). CONCLUSIONS PSA density represents a strong predictor for Gleason score upgrade after radical prostatectomy in patients with clinical low-risk disease. Since tumour upgrade increases the potential for postoperative pathological adverse findings and prognosis, PSA density should be considered when treating and consulting patients with low-risk prostate cancer.
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Van Praet C, Libbrecht L, D'Hondt F, Decaestecker K, Fonteyne V, Verschuere S, Rottey S, Praet M, De Visschere P, Lumen N. Agreement of Gleason score on prostate biopsy and radical prostatectomy specimen: is there improvement with increased number of biopsy cylinders and the 2005 revised Gleason scoring? Clin Genitourin Cancer 2013; 12:160-6. [PMID: 24361055 DOI: 10.1016/j.clgc.2013.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/08/2013] [Accepted: 11/08/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The objectives of this study were to assess the agreement of GS on biopsy compared with RP specimens and to assess whether an increased number of biopsy cylinders and the 2005 International Society of Urological Pathology (ISUP) GS modification improved this agreement. MATERIALS AND METHODS Pathological data of biopsy and RP specimens were analyzed in 328 consecutive patients, before (group 1; n = 135) and after (group 2; n = 193) implementation of the 2005 ISUP modification. Additionally, patients had more biopsy cylinders taken in group 2 (mean 10 vs. 6.9). The agreement of GS between biopsy and RP specimens was evaluated using the kappa coefficient. GS was pooled into 3 grades: low- (GS ≤ 6), intermediate- (GS = 7), and high-grade (GS ≥ 8) prostate cancer. RESULTS Kappa coefficient for GS in group 1 and 2 was 0.261 and 0.341, respectively. For tumor grade, this was 0.308 and 0.359 for group 1 and 2, respectively. For RP specimens, there was more agreement between biopsy and RP GS in group 2 compared with group 1 (53.9% vs. 37.8%). Upgrading was almost exclusively (89.5%) seen in patients with biopsy GS ≤ 6 and was lower in group 2 (25.4% vs. 48.1%) because of classification of more intermediate- and high-grade tumors using the 2005 ISUP modification. Taking > 6 biopsy cylinders was associated with better GS and tumor grade agreement. CONCLUSION Extended biopsy template and the 2005 ISUP modification resulted in an improved agreement between biopsy GS and RP GS and a shift toward more aggressive tumors.
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Affiliation(s)
| | - Louis Libbrecht
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Valérie Fonteyne
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | | | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Marleen Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Characteristics of modern Gleason 9/10 prostate adenocarcinoma: a single tertiary centre experience within the Republic of Ireland. World J Urol 2013; 32:1067-74. [DOI: 10.1007/s00345-013-1184-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022] Open
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Billis A, Quintal MM, Meirelles L, Freitas LL, Costa LB, Bonfitto JF, Diniz BL, Poletto PH, Magna LA, Ferreira U. The value of the 2005 International Society of Urological Pathology (ISUP) modified Gleason grading system as a predictor of biochemical recurrence after radical prostatectomy. Int Urol Nephrol 2013; 46:935-40. [DOI: 10.1007/s11255-013-0579-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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Contemporary Grading for Prostate Cancer: Implications for Patient Care. Eur Urol 2013; 63:892-901. [DOI: 10.1016/j.eururo.2012.10.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/09/2012] [Indexed: 01/19/2023]
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Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013; 111:753-60. [PMID: 23464824 DOI: 10.1111/j.1464-410x.2012.11611.x] [Citation(s) in RCA: 483] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The Gleason scoring system is a well-established predictor of pathological stage and oncological outcomes for men with prostate cancer. Modifications throughout the last few decades - most recently by the International Society of Urological Pathology (ISUP) in 2005 - have attempted to improve the correlation between biopsy and radical prostatectomy Gleason sum and better stratify patients to predict clinical outcomes. Based on these clinical outcomes and the excellent prognosis for patients with low Gleason scores, we recommend Gleason grades incorporating a prognostic grade grouping which accurately reflect prognosis and are clearly understood by physicians and patients alike. OBJECTIVE To investigate pathological and short-term outcomes since the most recent Gleason system modifications by the International Society of Urological Pathology (ISUP) in an attempt to divide the current Gleason grading system into prognostically accurate Gleason grade groups. PATIENTS AND METHODS We queried the Johns Hopkins Radical Prostatectomy Database (1982-2011), approved by the institutional review board, for men undergoing radical prostatectomy (RP) without a tertiary pattern since 2004 and identified 7869 men. Multivariable models were created using preoperative and postoperative variables; prognostic grade group (Gleason grade ≤ 6; 3 + 4; 4 + 3; 8; 9-10) was among the strongest predictors of biochemical recurrence-free (BFS) survival. RESULTS Significant differences were noted among the Gleason grade groups at biopsy; differences were noted in the race, PSA level, clinical stage, number of positive cores at biopsy and the maximum percentage of positive cores among the Gleason grade groups at RP. With a median (range) follow-up of 2 (1-7) years, 5-year BFS rates for men with Gleason grade ≤ 6, 3 + 4, 4 + 3, 8 and 9-10 tumours at biopsy were 94.6, 82.7, 65.1, 63.1 and 34.5%, respectively (P < 0.001 for trend); and 96.6, 88.1, 69.7, 63.7 and 34.5%, respectively (P < 0.001), based on RP pathology. CONCLUSIONS The 2005 ISUP modifications to the Gleason grading system for prostate carcinoma accurately categorize patients by pathological findings and short-term biochemical outcomes but, while retaining the essence of the Gleason system, there is a need for a change in its reporting to more closely reflect tumour behaviour. We propose reporting Gleason grades, including prognostic grade groups which accurately reflect prognosis as follows: Gleason score ≤ 6 (prognostic grade group I); Gleason score 3+4=7 (prognostic grade group II); Gleason score 4+3=7 (prognostic grade group III); Gleason score 4+4=8 (prognostic grade group (IV); and Gleason score 9-10 (prognostic grade group (V).
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Affiliation(s)
- Phillip M Pierorazio
- Department of Urology, The Johns Hopkins Medical Institutions and The James Brady Buchannan Urological Institute, Baltimore, MD, USA
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Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes? Am J Surg Pathol 2012; 36:1346-52. [PMID: 22531173 DOI: 10.1097/pas.0b013e3182556dcd] [Citation(s) in RCA: 244] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although rare, there are cases within reported series of men with Gleason score (GS) ≤6 on radical prostatectomies that show pelvic lymph node (LN) metastases. However, there are no studies on whether pelvic LN metastases occur in tumors with GS ≤6 using the International Society of Urological Pathology (ISUP) updated GS system. We performed a search of the radical prostatectomy databases at 4 large academic centers for cases of GS ≤6. Only prostatectomies submitted and embedded in entirety with pelvic LN dissections were included. A combined total of 14,123 cases were identified, of which 22 cases had a positive LN. Histopathologic review of 19 cases (3 cases unavailable for review) showed higher grade than originally reported by the pathologists in all cases. Of the 17 pre-ISUP reviewed cases, 2 were upgraded to 4+3=7 with both cribriform and poorly formed glands. One case was upgraded to 4+3=7 with tertiary pattern 5 displaying cribriform glands, poorly formed glands, and cords of single cells. Eleven cases were upgraded to 3+4=7 with glomeruloid structures and small to large cribriform glands (1 of these also had features of ductal adenocarcinoma). Two cases had tertiary pattern 4 with small cribriform glands. One case had a prominent colloid component that would currently be graded as 4+5=9 because of large cribriform glands and solid sheets of cells within the mucin. Of the 2 post-ISUP cases, 1 demonstrated tertiary pattern 4, and the other showed GS 3+4=7 with irregular cribriform glands. Undergrading is the primary reason for LN positivity with GS ≤6, which has decreased significantly since the adoption of the ISUP grading system in 2005. Of over 14,000 totally embedded radical prostatectomies from multiple institutions, there was not a single case of a GS ≤6 tumor with LN metastases. In contrast to prevailing assumptions, GS ≤6 tumors do not appear to metastasize to LNs. Rather, Gleason pattern 4 or 5, as better defined by the current ISUP updated grading system, is required for metastatic disease.
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Delahunt B, Miller RJ, Srigley JR, Evans AJ, Samaratunga H. Gleason grading: past, present and future. Histopathology 2012; 60:75-86. [PMID: 22212079 DOI: 10.1111/j.1365-2559.2011.04003.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 1966 Donald Gleason developed his grading and scoring system for prostatic adenocarcinoma. This classification was refined in 1974 and gained almost universal acceptance, being classified as a category 1 prognostic parameter by the College of American Pathologists. Modifications to the classification were recommended at a conference convened by the International Society of Urological Pathology (ISUP) in 2005. This modified classification has resulted in a significant upgrading of tumours, although some studies have shown a greater concordance between needle biopsy and radical prostatectomy scores when compared to classical Gleason (CG) grading. The ISUP consensus conference recommended that for needle biopsies higher tertiary patterns should be incorporated into the final Gleason score, and this has been correlated with biochemical failure, tumour volume and mortality. Recently the validity of including cribriform glands as a component of Gleason pattern 3 has been questioned and it has been recommended that all tumours showing cribriform architecture should be classified as Gleason pattern 4. The recommendations arising from the 2005 Consensus Conference were largely unsupported by validating data, yet this new grading system has achieved widespread usage. It is unfortunate that recent suggestions for further modification are similarly lacking in supporting evidence. In view of this it is recommended that the Modified Gleason Scoring Classification should continue to be utilized in its original (2005) format and that any future alterations should be implemented only when mandated by tumour-related outcome studies.
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Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
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A Contemporary Update on Pathology Reporting for Prostate Cancer: Biopsy and Radical Prostatectomy Specimens. Eur Urol 2012; 62:20-39. [DOI: 10.1016/j.eururo.2012.02.055] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/29/2012] [Indexed: 11/23/2022]
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45
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Impact on the Clinical Outcome of Prostate Cancer by the 2005 International Society of Urological Pathology Modified Gleason Grading System. Am J Surg Pathol 2012; 36:838-43. [DOI: 10.1097/pas.0b013e3182486faf] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Egevad L, Mazzucchelli R, Montironi R. Implications of the International Society of Urological Pathology modified Gleason grading system. Arch Pathol Lab Med 2012; 136:426-34. [PMID: 22458905 DOI: 10.5858/arpa.2011-0495-ra] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Histologic grading is the clinically most useful tissue-based predictor of prognosis for prostate cancer. Over the years, there has been a gradual shift in how the Gleason grading is applied in practice, with a general trend toward upgrading. A consensus conference was organized in 2005 by the International Society of Urological Pathology (ISUP) for standardizing both the perception of histologic patterns and how the grade information is compiled and reported. OBJECTIVE To review the implications of the ISUP modified Gleason grading system. DATA SOURCES Personal experience and review of the current literature. CONCLUSIONS The recommendations regarding pattern interpretation and reporting are summarized. The practical consequences of the ISUP modification of the Gleason grading are reported. The prognostic importance of the Gleason score, its reproducibility, and its preoperative assessment are discussed. Subsequent proposals for slight modifications to the ISUP grading system are described.
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Affiliation(s)
- Lars Egevad
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
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Oon SF, Pennington SR, Fitzpatrick JM, Watson RWG. Biomarker research in prostate cancer--towards utility, not futility. Nat Rev Urol 2012; 8:131-8. [PMID: 21394176 DOI: 10.1038/nrurol.2011.11] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The identification of an appropriate clinical question is critical for any biomarker project. Despite rapid advances in technology, few biomarkers have been forthcoming for prostate cancer. This could be because the clinical questions under investigation have not actually originated from clinical practice. These clinical questions are difficult to identify in the complex and heterogeneous pathogenesis of prostate cancer. In this Review, we have developed a prostate cancer 'roadmap' to identify the aspects of prostate cancer that may be amenable to biomarker discovery and serve as a guide for future projects in prostate cancer biomarker research.
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Affiliation(s)
- Sheng Fei Oon
- UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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Prognostic factors in prostate cancer. Key elements in structured histopathology reporting of radical prostatectomy specimens. Pathology 2011; 43:410-9. [DOI: 10.1097/pat.0b013e328348a6b3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Brookman-May S, May M, Wieland WF, Lebentrau S, Gunia S, Koch S, Gilfrich C, Roigas J, Hoschke B, Burger M. Should we abstain from Gleason score 2–4 in the diagnosis of prostate cancer? Results of a German multicentre study. World J Urol 2010; 30:97-103. [DOI: 10.1007/s00345-010-0632-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022] Open
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