Abstract
Objective: To evaluate the clinicopathological characteristics of grade group 1 (GG1) prostate cancer in Korean populations. Methods: We retrospectively analyzed 492 consecutive radical prostatectomy specimens from our institution, which included those from 322 men with clinical GG1 and 170 with clinical GG2 tumors between years 2009 and 2018. The incidence of Gleason score (GS) upgrading, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) were evaluated in patients with clinical GG1. In pathological GG1 cases, the distribution of adverse pathological features including EPE, lymphovascular invasion (LVI), perineural invasion (PNI), and biochemical recurrence (BCR) was analyzed. Results: Altogether, 78 (24.2%) out of 322 men in the clinical GG1 group demonstrated upgrading of GS, including 19 men with pathological Gleason score 4 + 3 = 7 and 6 with ≥ pathological Gleason score 4 + 4 = 8 cases. EPE was found in 37 (11.5%) and 22 (8.9%) men in clinical GG1 and pathological GG1 group, respectively. The incidence of LVI and PNI in the pathological GG1 cases was 2.8% (n = 7) and 28.6% (n = 71), respectively. BCR was observed in 4 men in pathological GG1 T2 (n = 226) and 2 men in GG1 T3 (n = 22) group. When we compared the pathological features between pathological GG1 T3 vs. GG2 T2, there was no statistical differences in the incidence of LVI and PNI between the two groups. Conclusions: Contrary to the current concept that GG1 is almost always clinically insignificant, it seems that GG1 still possess its respectable position as a group of cancer with aggressiveness. These findings should be kept in mind when deciding on treatment options for prostate cancer patients in the Asian populations.
Highlights
The Gleason system has been compressed into so-called grade groups (GGs)
When we compared the pathological features between pathological grade group 1 (GG1) T3 vs. GG2 T2, there was no statistical differences in the incidence of lymphovascular invasion (LVI) and perineural invasion (PNI) between the two groups
Contrary to the current concept that GG1 is almost always clinically insignificant, it seems that GG1 still possess its respectable position as a group of cancer with aggressiveness
Summary
The Gleason system has been compressed into so-called grade groups (GGs). The new GG system was validated in two large cohorts (men treated with radical prostatectomy (RP) or radiation), and both studies discovered that GGs predicted the risk of recurrence following the primary treatment [1, 2]. The five-year biochemical recurrence (BCR)-free progression probabilities after RP for GGs 1 through 5 were 96% (95% confidence interval (CI), 95–96), 88% (95% CI, 85–89), 63% (95% CI, 61–65), 48% (95% CI, 44–52), and 26% (95% CI, 23–30), respectively [1]. Many experts believe that the International Society of Urological Pathology (ISUP) GGs will enable patients to better understand their true risk level. In 2019, the National Comprehensive Cancer Network panels have accepted the new GG system to conduct better treatment discussions compared to those using Gleason score (GS)
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