Gleason scoring: a comparison of classical and modified (International Society of Urological Pathology) criteria using nadir PSA as a clinical end point

Delahunt, Brett; Lamb, David; Srigley, John R.; Murray, Janice; Wilcox, Chantelle; Samaratunga, Hemamali; Ch, Atkinson; Spry, Nigel; Joseph, David; Denham, James W.

doi:10.3109/00313021003787924

Cited by 45 publications

(52 citation statements)

References 15 publications

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“…In a more recent study that evaluated 590 biopsy specimens according to the classic and modified GS, the number of cores with 75-100% pattern 4 cancer was increased by 95% (10). Over the last few years, the bioptic GS has become increasingly important, since several patients may be offered therapeutic alternatives to radical prostatectomy, such as active surveillance, and prostate biopsy results represent a crucial point in the management of the disease.…”

Section: Introductionmentioning

confidence: 99%

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

D’Elia¹,

Cerruto²,

Cioffi³

et al. 2014

Molecular and Clinical Oncology

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Abstract. Prostate cancer (CaP) is the most common malignancy in men and the second cause of cancer-related mortality after lung cancer. Several studies have evaluated the correlation between bioptic and pathological Gleason score (GS), documenting a correlation ranging between 30 and 60%. The aim of this study was the evaluation of the association between bioptic and pathological GS in a series of patients undergoing prostate needle biopsy and subsequent radical prostatectomy. We also aimed to evaluate the possible prognostic factors of upgrading and upstaging. We prospectively collected and retrospectively reviewed data from 300 consecutive patients who underwent radical retropubic or robot-assisted prostatectomy at our Institution. Patients who underwent prostate needle biopsy, transrectal or transperineal, with a minimum of 5 samples, were included in this study. Upgrading and downgrading were defined as increase or decrease, respectively, from one prognostic grade group to another, similar to up-or downstaging. The mean age of the patients was 62.97 years and the mean prostate-spesific antigen (PSA) level was 7.83 ng/ml. A total of 51.3% of the population underwent a transperineal prostate biopsy. The most frequently represented bioptic GS was 3+3 (64.0%) followed by 3+4=7 (15.6%); the most frequent pathological Gleason score was 3+4 (44.3%), followed by 3+3 (31.0%). With reagard to the bioptic GS 4-5-6 group, approximately half of the specimens (46.7%) were subsequently upgraded to GS 3+4, and 5.3% to 4+3. With regards to the bioptic GS 3+4 group, 57.4% was confirmed in the surgical specimen. In the 4+3 group, 23.5% of the cases was downgraded to 3+4 and 35.3% was confirmed. With regards to stage, ~39.7% of the patients received an upstaging on the pathological specimen. We evaluated the correlations between preoperative serum PSA level, prostate volume, digital rectal examination and biopsy type and none of the variables considered exhibited a correlation with any upgrading (P>0.05). Moreover, we evaluated the correlations between the aforementioned variables and upstaging and, at the multivariate analysis, only a serum PSA <4 ng/ml was found to be an independent variable predictive of upstaging (P=0.017). Therefore, new tools are required to predict upgrading and upstaging of our patients, in order to ensure better counseling for optimal treatment planning.

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Section: Introductionmentioning

confidence: 99%

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

D’Elia¹,

Cerruto²,

Cioffi³

et al. 2014

Molecular and Clinical Oncology

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“…Furthermore, while inter-observer variability and the general upgrading of tumours using the modified Gleason scoring has been well-documented, 21 the predictive value of PSA changes from nadir is maintained. 22 There is also a good correlation between tumour grade and stage, and serum PSA values, which may further characterize the difference between low-and high-grade malignancy of prostate carcinoma. [22][23][24] The findings in the present study are further supported by the recent Consensus Statement from the Canadian Urological Association.…”

Section: Discussionmentioning

confidence: 99%

“…22 There is also a good correlation between tumour grade and stage, and serum PSA values, which may further characterize the difference between low-and high-grade malignancy of prostate carcinoma. [22][23][24] The findings in the present study are further supported by the recent Consensus Statement from the Canadian Urological Association. 25 The statement critically analyzed the available data on the benefit-risk of 5-ARIs.…”

Section: Discussionmentioning

confidence: 99%

The effect of dutasteride on the detection of prostate cancer: A set of meta-analyses

Monga

Sayani

Rubinger

et al. 2013

CUAJ

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Background: Dutasteride has been shown to significantly improve symptoms of benign prostatic hyperplasia (BPH) and reduce clinical progression. Recent data from studies evaluating 5-alpha reductase inhibitors (5-ARIs) for the prevention of prostate cancer, however, suggest 5ARIs, including dutasteride, may be associated with increased incidence of Gleason 8-10 prostate tumours. This metaanalysis was undertaken to quantify the effect of dutasteride on detection of prostate cancer and high-grade prostate cancer. Methods: Our meta-analysis includes data from GlaxoSmithKlinesponsored phase III randomized clinical trials (with a study duration of ≥2 years) evaluating the effect of dutasteride, alone or in combination with tamsulosin, to treat BPH or to reduce the risk of prostate cancer. The incidence of prostate cancer, including Gleason 7-10 and Gleason 8-10, for patients taking either dutasteride, dutasteride plus tamsulosin, tamsulosin alone, or placebo, were evaluated using the Mantel-Haenszel Risk Ratio (MHRR) method of conducting meta-analyses. Results:The meta-analysis demonstrated that in a population with symptomatic BPH and/or at increased risk of prostate cancer, a statistically significant lower number of detectable prostate cancers was found in men taking dutasteride compared to control groups (MHRR: 0.66, 95% CI 0.52-0.85). In our analysis, there was no increased risk for Gleason 7-10 (MHRR: 0.83, 95% CI 0.56-1.21) or Gleason 8-10 prostate cancers (MHRR: 0.99, 95% CI 0.39-2.53) in men taking dutasteride over control groups. There were several limitations that need to be considered when interpreting these results. Conclusion: These data provide support for the continued use of dutasteride in the treatment of symptomatic BPH patients.

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“…This has resulted in a Gleason score 3 + 3 = 6 category that is more homogeneously low risk at the expense of a more biologically heterogeneous Gleason score 3 + 4 = 7 category. Patients with a biopsy Gleason score of 3 + 4 = 7, who previously could have been scored as Gleason score 3 + 3 = 6, may not have as aggressive a cancer as current algorithms might predict [9][10][11][12]. Several recent studies have examined the use of biopsy Gleason score ≤3 + 4 = 7 as inclusion criteria for AS but have had mixed results, probably due to the biological heterogeneity of this group [13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Does cumulative prostate cancer length (CCL) in prostate biopsies improve prediction of clinically insignificant cancer at radical prostatectomy in patients eligible for active surveillance?

et al. 2014

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ObjectivesTo evaluate if cumulative prostate cancer length (CCL) on prostate needle biopsy divided by the number of biopsy cores (CCL/core) could improve prediction of insignificant cancer on radical prostatectomy (RP) in patients with prostate cancer eligible for active surveillance (AS). Patients and MethodsPatients diagnosed with prostate cancer on extended (≥10 cores) biopsy with an initial prostate-specific antigen (iPSA) level of <15 ng/mL, clinical stage (cT) ≤ 2a, and highest biopsy Gleason score 3 + 3 = 6 or 3 + 4 = 7 with <3 positive cores who underwent RP were included in the study. The CCL/core and presence of insignificant cancer (organ-confined, volume <0.5 mL, Gleason score at RP ≤6) were recorded. pT2 prostate cancer with RP Gleason score ≤3 + 4 = 7 and volume <0.5 mL were categorised as low-tumour-volume organ-confined disease (LV-OCD). ResultsIn all, 221 patients met the inclusion criteria: the mean age was 59 years and the median iPSA level was 4.5 ng/mL. The clinical stage was cT1 in 86% of patients; biopsy Gleason score was 3 + 3 = 6 in 67% (group 1) and 3 + 4 = 7 in 33% of patients (group 2). The maximum percentage of biopsy core involvement was <50 in 85%; the median CCL/core was 0.15 mm. Insignificant cancer was found in 27% and LV-OCD in 44% of patients. Group 2 was associated with higher number of positive cores, maximum percentage core involvement, total prostate cancer length, and CCL/core. Group 1 was more likely to have insignificant cancer (39%) or LV-OCD (54%) than group 2 (3% and 23%, respectively). Group 2 had significantly higher RP Gleason score and pathological stage. Univariate analysis of group 1 showed that the iPSA level, maximum percentage core involvement, prostate cancer length, and CCL/core were all significantly associated with insignificant cancer and LV-OCD. For group 2, the number of positive cores (1 vs 2) was also significantly associated with LV-OCD. On multivariate logistic regression analysis, maximum percentage core involvement of <50, and number of positive cores (1 vs 2) were independent predictors of insignificant cancer in group 1; biopsy Gleason score, maximum percentage core involvement of <50 and prostate cancer length of <3 mm or CCL/core of <0.2 mm were all independent predictors of LV-OCD in the whole population. The maximum percentage of core involvement of <50 and prostate cancer length of <3 mm or CCL/core of <0.2 mm were also independent predictors of LV-OCD in group 1 patients.

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Gleason scoring: a comparison of classical and modified (International Society of Urological Pathology) criteria using nadir PSA as a clinical end point

Cited by 45 publications

References 15 publications

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

The effect of dutasteride on the detection of prostate cancer: A set of meta-analyses

Does cumulative prostate cancer length (CCL) in prostate biopsies improve prediction of clinically insignificant cancer at radical prostatectomy in patients eligible for active surveillance?

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