Population-Based Validation of the 2014 ISUP Gleason Grade Groups in Patients Treated With Radical Prostatectomy, Brachytherapy, External Beam Radiation, or no Local Treatment

Pompe, Raisa S.; Davis-Bondarenko, Helen; Zaffuto, Emanuele; Tian, Zhe; Shariat, Shahrokh F.; Leyh-Bannurah, Sami-Ramzi; Schiffmann, Jonas; Saad, Fred; Huland, Hartwig; Graefen, Markus; Tilki, Derya; Karakiewicz, Pierre I.

doi:10.1002/pros.23316

Cited by 34 publications

(36 citation statements)

References 21 publications

(53 reference statements)

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“…Recommendations advocating management of senior adults according to health status rather than chronological age, were not implemented in the European Association of Urology Guidelines until 2016, but preceding discussions within the uro‐oncological community may have guided clinical practice earlier 30 . Furthermore, the overall increase in use of CurTrt across diagnostic periods reflects the increase in ISUP grade groups, being a strong predictor of unfavorable outcomes 31 …”

Section: Discussionmentioning

confidence: 99%

Increased curative treatment is associated with decreased prostate cancer‐specific and overall mortality in senior adults with high‐risk prostate cancer; results from a national registry‐based cohort study

et al. 2020

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Background The association between curative treatment (CurTrt) and mortality in senior adults (≥70 years) with high‐risk prostate cancer (PCa) is poorly documented. In a population‐based cohort we report temporal trends in treatment and PCa‐specific mortality (PCSM), investigating the association between CurTrt and mortality in senior adults with high‐risk PCa, compared to findings in younger men (<70 years). Methods Observational study from the Cancer Registry of Norway. Patients with high‐risk PCa were stratified for three diagnostic periods (2005‐08, 2009‐12 and 2013‐16), age (<70, vs ≥70) and primary treatment (CurTrt: Radical prostatectomy (RP), Radiotherapy (RAD) vs no curative treatment (NoCurTrt)). Competing risk and Kaplan‐Meier methods estimated PCSM and overall mortality (OM), respectively. Multivariable logistic regression models estimated odds for CurTrt, and multivariable Fine Gray and Cox regression models evaluated the hazard ratios for PCSM and OM. Results Of 19 763 evaluable patients, 54% were aged ≥70 years. Senior adults had more unfavorable PCa characteristics than younger men. Across diagnostic periods, use of CurTrt increased from 15% to 51% in men aged ≥70 and 65% to 81% in men aged < 70 years. With median five years follow‐up, PCSM decreased in all patients (P < .05), in the third period restricted to senior adults. In all patients NoCurTrt was associated with three‐fold higher 5‐year PCSM and two‐fold higher OM compared to CurTrt. Conclusions In high‐risk PCa patients, increased use of CurTrt, greatest in senior men, was observed along with decreased PCSM and OM in both senior and younger adults. CurTrt should increasingly be considered in men ≥70 years.

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Section: Discussionmentioning

confidence: 99%

Increased curative treatment is associated with decreased prostate cancer‐specific and overall mortality in senior adults with high‐risk prostate cancer; results from a national registry‐based cohort study

et al. 2020

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“…81 Additional studies have supported the validity of this new system. [82][83][84][85][86] The NCCN Panel has accepted the new Grade Group system to inform better treatment discussions compared with those using Gleason score. Patients remain divided into very low-, low-, intermediate-, high-, and very high-risk groups.…”

Section: Risk Stratification For Clinically Localized Diseasementioning

confidence: 99%

Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Mohler

Antonarakis

Armstrong

et al. 2019

Journal of the National Comprehensive Cancer Network

1,004

777

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The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for localized disease, and management of recurrent and advanced disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.

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“…It is well-known that the Gleason score is a very strong, possibly even the strongest, predictor of the behavior of prostate carcinomas, e.g., extraprostatic extension of the tumor, lymph node metastasis, biochemical recurrence, and metastases development [50,51]. …”

Section: Genetic/molecular Heterogeneitymentioning

confidence: 99%

“…Should it be demonstrated in further studies that intra- und intertumoral heterogeneity of prostate cancer warrants many more samples, the whole stratum of prognostic studies from several decades would be wiped out. Biobanking techniques would also be significantly affected [50]. …”

Section: Genetic/molecular Heterogeneitymentioning

confidence: 99%

The Heterogeneity of Prostate Cancer: A Practical Approach

Tolkach¹,

Kristiansen²

2018

Pathobiology

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Prostate cancer is a paradigm tumor model for heterogeneity in almost every sense. Its clinical, spatial, and morphological heterogeneity divided by the high-level molecular genetic diversity outline the complexity of this disease in the clinical and research settings. In this review, we summarize the main aspects of prostate cancer heterogeneity at different levels, with special attention given to the spatial heterogeneity within the prostate, and to the standard morphological heterogeneity, with respect to tumor grading and modern classifications. We also cover the complex issue of molecular genetic heterogeneity, discussing it in the context of the current evidence of the genetic characterization of prostate carcinoma; the interpatient, intertumoral (multifocal disease), and intratumoral heterogeneity; tumor clonality; and metastatic disease. Clinical and research implications are summarized and serve to address the most pertinent problems stemming from the extreme heterogeneity of prostate cancer.

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Population-Based Validation of the 2014 ISUP Gleason Grade Groups in Patients Treated With Radical Prostatectomy, Brachytherapy, External Beam Radiation, or no Local Treatment

Abstract: This large population-based cohort study confirms the added discriminant properties of the novel GGG strata and confirms a modest gain in predictive accuracy. Prostate 77: 686-693, 2017. © 2017 Wiley Periodicals, Inc.

Cited by 34 publications

References 21 publications

Increased curative treatment is associated with decreased prostate cancer‐specific and overall mortality in senior adults with high‐risk prostate cancer; results from a national registry‐based cohort study

Increased curative treatment is associated with decreased prostate cancer‐specific and overall mortality in senior adults with high‐risk prostate cancer; results from a national registry‐based cohort study

Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

The Heterogeneity of Prostate Cancer: A Practical Approach

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