The predictive factor for pathological downgrading after prostatectomy in patients with biopsy Gleason score 4+3 or 4+4 prostate cancer

Abstract

The proportion of Gleason pattern (GP) 4 prostate cancers at prostate biopsy has a clinically significant impact on risk stratification for patients with prostate cancer. In pathological diagnosis including GP 4, a biopsy Gleason score (GS) of 3+4 has a more favorable prognosis than a GS of 4+3 and 4+4. However, the discrepancy between biopsy and prostatectomy specimens is well known. The current study investigated the clinical parameters and biopsy specimens associated with pathological downgrading after prostatectomy in biopsies with a GS of 4+3 or 4+4 prostate cancer. A total of 302 patients with prostate cancer who underwent robot-assisted radical prostatectomy between August 2013 and May 2019 were retrospectively reviewed. A total of 103 patients had biopsies with GSs of 4+3 and GS 4+4 (unfavorable pathology). The proportion of patients who were downgraded from unfavorable disease to GS ≤3+4 (favorable pathology) in prostatectomy specimens was investigated. Logistic regression analysis was used to explore the association between clinical parameters and downgrading in prostatectomy specimens. A total of 43 patients (41.7%) were downgraded from biopsy GS to prostatectomy GS. The proportions of downgrade in biopsy GS 4+4 and 4+3 were 14.6 and 27.1%, respectively. The percentage of highest GS out of positive biopsy cores and the maximum percentage of cancer involvement within a positive core with the highest GS were lower in the downgrade group than in the no downgrade group (45 vs. 66.7%, P=0.025; 20 vs. 30%, P=0.048, respectively). When performing multivariate logistic regression analysis, the only significant predictor for downgrade was lower percentage of highest GS cores out of positive biopsy cores (odds ratio, 2.469; 95% confidence interval, 1.029-5.925 P=0.043). In conclusion, patients with biopsy GS 4+4 and 4+3 often exhibit a downgrade to GS 3+4 or less in prostatectomy specimens. The lower percentage of highest GS cores out of positive biopsy cores was associated with downgrade.

The prognostic value of 18F-PSMA-1007 PET/CT in predicting pathological upgrading of newly diagnosed prostate cancer from systematic biopsy to radical prostatectomy

“…These patients in our study were consequently downgraded from NCCN high-risk PCa to low-intermediate risk. Pathological analysis of the prostatectomy specimens may miss ISUP GG 4 due to the diagnosis of its small lesions ( 31 ). The rate of downgrading may be impacted by inadequate gland sampling on final RP pathological specimens ( 32 ).…”

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

“…High‐grade lesions on Bx with lower percentage and less positive cores on Bx may be interpreted as primary or secondary pattern, which will be re‐graded to tertiary pattern. Tohi et al 8 looked at patients with a Bx GS 4 + 3 and 4 + 4 undergoing RP, 41.7% of which downgraded to GS ≤ 3 + 4 at RP. The only significant factor predicting downgrading on multivariate logistic analysis was the lower percentage of highest GS cores out of positive Bx cores (odds ratio [OR] = 2.469, p = 0.043).…”

“…7 High-grade lesions on Bx with lower percentage and less positive cores on Bx may be interpreted as primary or secondary pattern, which will be re-graded to tertiary pattern. Tohi et al 8 Very few studies have reported the impact of Bx downgrading on the outcomes of patients with PCa, compared with those with no downgrading. Muntener et al 12 reported a cohort of 6625 men and 6.2% encountered downgrading at RP.…”