Prognostic Value of Percent Gleason Grade 4 at Prostate Biopsy in Predicting Prostatectomy Pathology and Recurrence

Cole, Adam; Morgan, Todd M.; Spratt, Daniel E.; Palapattu, Ganesh S.; He, Chang; Tomlins, Scott A.; Weizer, Alon Z.; Feng, Felix Y.; Wu, Angela; Siddiqui, Javed; Chinnaiyan, Arul M.; Montgomery, Jeffrey S.; Kunju, Lakshmi P.; Miller, David C.; Hollenbeck, Brent K.; Wei, John T.; Mehra, Rohit

doi:10.1016/j.juro.2016.01.120

Cited by 90 publications

(84 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…69 A more recent study that included >1600 patients separated into groups of 10% increases of Gleason pattern 4 in needle biopsies correlates with adverse pathological findings at RP both in patients with Gleason score 3 + 4 = 7 (GrG2) and in those with Gleason score 4 + 3 = 7 (GrG3), and with BCR. 70 A separate study that included >1200 patients also divided the patients into groups with increasing percentages of Gleason pattern 4, and found that a higher percentage of Gleason pattern 4 predicts EPE at RP. 71 Therefore, as more studies are being performed, it is possible that the percentage of Gleason pattern 4 will be included in prediction models for significant cancer.…”

Section: T U M O U R G R a D E A T N E E D L E B I O P S Y A S A P R mentioning

confidence: 99%

Defining clinically significant prostate cancer on the basis of pathological findings

2018

View full text Add to dashboard Cite

The definition of clinically significant prostate cancer is a dynamic process that was initiated many decades ago, when there was already evidence that a great proportion of patients with prostate cancer diagnosed at autopsy never had any clinical symptoms. Autopsy studies led to examinations of radical prostatectomy (RP) specimens and the establishment of the definition of significant cancer at RP: tumour volume of 0.5 cm3, Gleason grade 6 [Grade Group (GrG) 1], and organ‐confined disease. RP studies were then used to develop prediction models for significant cancer by the use of needle biopsies. The first such model was used to delineate the first active surveillance (AS) criteria, known as the ‘Epstein’ criteria, in which patients with a cancer Gleason score of 3 + 3 = 6 (GrG1) involving fewer than two cores, and <50% of any given core, and a prostate‐specific antigen density of <0.15 ng/ml per cm3 had a minimal risk of significant cancer at RP. These were adopted as components of the ‘very‐low‐risk category’ of the National Comprehensive Cancer Network guidelines, in which AS is supported as a management option. With the increase in the popularity of AS, much research has been carried out to better define significant/insignificant cancer, in order to be able to safely offer AS to a larger proportion of patients without the risk of undertreatment. Research has focused on allowing higher volume tumours, focal extraprostatic extension, and a limited amount of Gleason pattern 4, and the significance of different morphological patterns of Gleason 4. Other areas of research that will probably impact on the field but that are not covered in this review include the molecular classification of tumours and imaging techniques.

show abstract

Section: T U M O U R G R a D E A T N E E D L E B I O P S Y A S A P R mentioning

confidence: 99%

Defining clinically significant prostate cancer on the basis of pathological findings

2018

View full text Add to dashboard Cite

show abstract

“…Further, a global Gleason score is generally reported taking into account the grade patterns of the carcinoma foci encountered in all cores. Although it may seem counterintuitive, three recent studies showed that the global Gleason score outperformed the ‘worst’ Gleason score with regard to pathological features in corresponding prostatectomy specimens …”

Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

“…Subsequent studies on quantitative grading showed the incremental, rather than acute, increase in risk of biochemical recurrence at higher proportions of the grade 4 component. It is thought that quantitative grading might limit the clinical impact of interobserver variation regarding borderline findings such as tumours with, for instance, very small Gleason grade 4 fractions impacting a man's eligibility for active surveillance . One study reported that interobserver reproducibility of percent Gleason grades 4 or 5 on prostate biopsies is at least as good as that of Gleason score .…”

Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

“…Although it may seem counterintuitive, three recent studies showed that the global Gleason score outperformed the 'worst' Gleason score with regard to pathological features in corresponding prostatectomy specimens. [50][51][52] Grading of prostatectomy specimens follows slightly different rules compared to biopsy grading: if no clearly spatially separate carcinoma foci with disparate grade are detected a 'global' ISUP grade is reported. If a predominant Gleason grade 3 carcinoma is identified with a minor (i.e.…”

Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

See 1 more Smart Citation

Grading of prostate cancer: a work in progress

2018

View full text Add to dashboard Cite

Grading of prostate cancer has evolved substantially over time, not least because of major changes in diagnostic approach and concomitant shifts from late‐ to early‐stage detection since the adoption of PSA testing from the late 1980s. After the conception of the architecture‐based nine‐tier Gleason grading system more than 50 years ago, several changes were made in order to increase its prognostic impact, to reduce interobserver variation and to improve concordance between prostate needle biopsy and radical prostatectomy grading. This eventually resulted in the current five‐tier grading system, with a much more detailed description of the individual architectural patterns constituting the remaining three Gleason patterns (i.e. grades 3–5). Nevertheless, there is room for improvement. For instance, distinction of common grade 4 subpatterns such as ill‐formed and fused glands from the grade 3 pattern is challenging, blurring the division between low‐risk patients who could be eligible for deferred therapy and those who need curative therapy. The last few years have witnessed the publication of several studies on the prognostic impact of individual architectural subpatterns showing that, in particular, the cribriform pattern exceeded the prognostic impact of other grade 4 subpatterns. This review provides an overview of the changes in prostate cancer grading over time and provides a thorough description of the various Gleason subpatterns, the current evidence of their prognostic impact and areas of contention. Potential practical ways for improvements of the current grading system are also put forward.

show abstract

“…Recently, an exceptionally large cohort of 12 823 consecutive patients and of 2971 matched preoperative biopsies was used to validate the importance of assigning the percentage of Gleason pattern 4 and 5 with biochemical relapse . This has been validated in a number of other studies, and it has been suggested, for instance, that the percentage of grade 4 may be used to determine criteria for active surveillance in those with minimal grade 4 disease …”

Section: Introductionmentioning

confidence: 99%

The percentage of high‐grade prostatic adenocarcinoma in prostate biopsies significantly improves on Grade Groups in the prediction of prostate cancer death

et al. 2019

View full text Add to dashboard Cite

Aims It has been recommended that the percentage of high‐grade (HG) Gleason patterns 4 and 5 should be quantified in prostate cancer. However, this has not been assessed in a cohort using prostate cancer death as an outcome, and there is debate as to whether the biopsy with the ‘worst’ percentage of HG disease or an ‘overall’ percentage of HG disease should be reported. Such data may assist in active surveillance decisions. Methods and results Men with clinically localised prostate cancer diagnosed by needle biopsy from 1990 to 2003 were included. The endpoint was prostate cancer death. Clinical variables included Gleason score (GS), prostate‐specific antigen level, age, clinical stage, and disease extent. Deaths were divided into those from prostate cancer and those from other causes, according to World Health Organization criteria. Nine hundred and eighty‐eight biopsy cases were centrally reviewed according to criteria agreed at the Chicago International Society of Urological Pathology conference in 2014. Cores were given individual GSs and Grade Groups (GGs), and a percentage of each grade was given for each core. Both the worst percentage of HG disease seen in a biopsy series and overall percentage of HG disease were calculated. The overall percentage of HG disease was highly significant, with a hazard ratio of 4.45 for the interquartile range (95% confidence interval 3.30–6.01, P < 2.2 × 10−16), and was similar to the percentage of HG disease seen in the worst core. In multivariate analysis, both were highly significant. GG2 cases with ≤5% Gleason pattern 4 showed similar survival to GG1 cases. Conclusions These data validate the use of percentage of HG disease to predict prostate cancer death. As both worst and overall percentage of HG disease are powerful predictors of outcome, either could be chosen to provide prognostic information.

show abstract

Prognostic Value of Percent Gleason Grade 4 at Prostate Biopsy in Predicting Prostatectomy Pathology and Recurrence

Cited by 90 publications

References 28 publications

Defining clinically significant prostate cancer on the basis of pathological findings

Defining clinically significant prostate cancer on the basis of pathological findings

Grading of prostate cancer: a work in progress

The percentage of high‐grade prostatic adenocarcinoma in prostate biopsies significantly improves on Grade Groups in the prediction of prostate cancer death

Contact Info

Product

Resources

About