Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4 + 4 = 8

Harding-Jackson, Nicholas; Kryvenko, Oleksandr N.; Whittington, Elizabeth; Eastwood, Daniel; Tjionas, George A.; Jordà, Mercè; Iczkowski, Kenneth A.

doi:10.1016/j.juro.2016.05.105

Cited by 56 publications

(37 citation statements)

References 14 publications

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“…For instance, we noted in our cohort that men with GG4 disease without CR/IDC had DSS rates comparable [ 5 1 _ T D $ D I F F ] to those with GG2 and GG3 disease. This is in line with the findings of Harding-Jackson et al [ 5 2 _ T D $ D I F F ] [27], who also found relatively good outcome in GG4 Pca patients without cribriform pattern. With the introduction of the GG system, all patients with GS8 are classified as GG4 Pca patients irrespective of the GS being 3 + 5, 4 + 4, or 5 + 3.…”

Section: Discussionsupporting

confidence: 92%

“…With the introduction of the GG system, all patients with GS8 are classified as GG4 Pca patients irrespective of the GS being 3 + 5, 4 + 4, or 5 + 3. Van den Bergh et al found that men with GS 3 + 5 = 8 had significantly better BCRFS than GS8 patients with any of the other grade combinations, although such a difference could not be confirmed by others [ 5 3 _ T D $ D I F F ] [26][27][28]. Detailed analyses for the presence of CR/IDC in this heterogeneous population of GG4 Pca patients might further improve Pca grading.…”

Section: Discussionmentioning

confidence: 80%

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Improved Prostate Cancer Biopsy Grading by Incorporation of Invasive Cribriform and Intraductal Carcinoma in the 2014 Grade Groups

et al. 2020

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E U R O P E A N U R O L O G Y 7 7 ( 2 0 2 0 ) 1 9 1 -1 9 8 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Background: Grade groups (GGs) are an important parameter for therapeutic decision making in prostate cancer (Pca) patients. Invasive cribriform and/or intraductal carcinoma (CR/IDC) has an independent prognostic value for disease outcome, but are not included in the GG limiting their clinical use. Objective: To perform a proof-of-principle study incorporating CR/IDC in the current GG. Design, setting, and participants: All prostate biopsies of 1031 men with screen-detected Pca between 1993 and 2000 were reviewed for the current GG (ranging from 1 to 5) and CR/IDC. The cribriform grade (cGrade) was equal to the GG if CR/IDC was present and GG minus 1 if not. GG1 was cGrade1 if intraductal carcinoma was absent. Intervention: Biopsy review for GG and CR/IDC. A total of 406 patients had received radical prostatectomy (RP), 508 radiotherapy (RT), 108 surveillance, and eight hormonal therapy, and the treatment was unknown for one patient.Outcome measurements and statistical analysis disease-specific survival (DSS), metastasisfree survival (MFS), and biochemical recurrence-free survival (BCRFS) after 15.1 yr (interquartile range 10.9-19.7 yr) follow-up were compared using Harrell's C-statistic. Results and limitations: The biopsy GGs were 486 GG1, 310 GG2, 104 GG3, 64 GG4, and 67 GG5; cGrade distributions were 738 cGrade1, 102 cGrade2, 91 cGrade3, 58 cGrade4, and 42 cGrade5. The cGrade had a better discriminative value than the GG for DSS (C-index 0.79; 95% confidence interval 0.74-0.83 vs 0.76; 0.71-0.82) and MFS (0.79; 0.74-0.84 vs 0.77; 0.72-0.82). The discriminative value for BCRFS after RP and RT was similar for both models. Different diagnostic, such as use of sextant biopsies, and therapeutic strategies in the 1990s are the limitations of this study. Conclusions: The cGrade is a simple Pca grade modification with better discriminative values for DSS and MFS than the GG, particularly impacting decision making in men with current GG2 Pca. Patient summary: Microscopic grading is an important factor for decision making in prostate cancer (Pca) patients. We show that [ 4 5 _ T D $ D I F F ] a simple grade modification better predicts Pca outcome and might improve treatment choices.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 80%

Improved Prostate Cancer Biopsy Grading by Incorporation of Invasive Cribriform and Intraductal Carcinoma in the 2014 Grade Groups

et al. 2020

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“…74 Notably, among Gleason score 8 cancers, the question of whether the highest Gleason grade was 3 + 5 versus 4 + 4 proved only mildly predictive of recurrence. However, the presence of cribriform cancer dichotomised cancer-specific survival in Gleason 8 cancer, 75 corroborating another large biopsy-based study showing that across all Gleason score >6 carcinomas, the presence of a cribriform pattern predicted metastatic disease and death of disease. 63 Together, these studies indicate that cribriform architecture in prostate cancer carries a much higher risk of disease progression compared to the other Gleason grade 4 patterns.…”

Section: Glomeruloid Architecturesupporting

confidence: 76%

Grading of prostate cancer: a work in progress

2018

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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.

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“…The consensus grade differed from the initial grading of the case by the submitting pathologist in only three cases (one with higher consensus grade and two with lower grades). Among the seven cases listed as Other grade (Table ), one case of GS 2 + 3 = 5 and six cases of GS 3 + 5 = 8 were grouped with ISUP 1 and 4, respectively, for further analysis; however, this did not alter any of the consensus decisions.…”

Section: Resultsmentioning

confidence: 99%

Utility of Pathology Imagebase for standardisation of prostate cancer grading

et al. 2018

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Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4 + 4 = 8

Abstract: Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 = 8 and 4 + 4 = 8 cancers. This justifies including both in Grade Group 4.

Cited by 56 publications

References 14 publications

Improved Prostate Cancer Biopsy Grading by Incorporation of Invasive Cribriform and Intraductal Carcinoma in the 2014 Grade Groups

Improved Prostate Cancer Biopsy Grading by Incorporation of Invasive Cribriform and Intraductal Carcinoma in the 2014 Grade Groups

Grading of prostate cancer: a work in progress

Utility of Pathology Imagebase for standardisation of prostate cancer grading

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