Predictive Factors and Oncologic Outcome of Downgrade to Pathologic Gleason Score 6–7 after Radical Prostatectomy in Patients with Biopsy Gleason Score 8–10

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.

Prostate cancer grade downgrading at time of prostatectomy provides risk‐stratification insight into future tumor behavior after prostatectomy

“…Based on that, the authors suggested that Bx grade could add additional prognostic value and may be used for risk stratification. Chung et al 13 in another study also reported an adverse impact of downgrading on biochemical recurrence, with 38% (332/860) of PCa patients downgraded to GS ≤ 7 at time of RP. In our study, we found that downgrading independently increased the risk of CSM by 45%, indicating that those tumors may be more aggressive compared with those with lower Bx GG, even though the final whole gland GGs were the same.…”

Urinary proteomic profiles of prostate cancer with different risk of progression and correlation with histopathological features

“…This classification is based on disease characteristics such as stage, grading and prostate specific antigen (PSA) levels [2][3][4][5]. Important known unfavorable histological prognostic features, such as high grade cancer (Gleason grade ≥ 4/ Prognostic Grade Group System ≥4) [6][7][8], vascular lymphatic invasion, extraprostatic extension and advanced stage p disease [9], are not prognostic reliable predictors as opposed to periodic serum PSA level assay, which is now considered the gold standard for PCa monitoring. Although new histopathological diagnostic approaches are emerging, such as early detection of neoplasia [10][11][12][13], there are still a few studies on the validation of proteomic markers.…”