Abstract
Objective: To investigate the relationship between the new International Society of Urological Pathology (ISUP) grading system, biochemical recurrence (BCR), clinical progression (CP) and cancer related death (CRD) after open radical prostatectomy (RP) and determine whether the 2014 ISUP grading system influences the concept of high-risk prostate cancer (HRPCa).Patients and Methods: A total of 1,754 men who underwent RP from 2005 to 2017 were identified from a database at a single tertiary institution. Histopathology reports were reassessed according to the 2014 ISUP grading system. All preoperative, pathological, and clinical follow-up data were obtained. Univariable and multivariable Cox regression, Kaplan-Meier and log-rank analyses were performed.Results: At a median (quartiles) follow-up of 83 (48–123) months, 446 men (25.4%) had BCR, 77 (4.4%) had CP and 39 (2.2%) died from cancer. Grade groups 1, 2, 3, 4, and 5 were detected in 404 (23%), 931 (53.1%), 200 (11.4%), 93 (5.3%), and 126 (7.2%), respectively. 10-year biochemical progression free survival difference between Grade group 3 and 4 was minor but significant (log-rank p = 0.045). There was no difference between Grade groups 3 and 4 comparing 10-year clinical progression free and 10-year cancer specific survival: p = 0.82 and p = 0.39, respectively. Group 5 had the worst survival rates in comparison with other groups (from p < 0.005 to p < 0.0001) in all survival analyses. Pathological stage (hazard ratio (HR) 2.6, p < 0.001), positive surgical margins (HR 2.2, p < 0.0001) and Grade group (HR 10.4, p < 0.0001) were independent predictors for BCR. Stage and Grade group were detected as independent predictors for CP–HR 6.0, p < 0.0001 and HR 35.6, p < 0.0001, respectively. Only Grade group 5 (HR 12.9, p = 0.001) and pT3b (HR 5.9, p = 0.001) independently predicted CRD.Conclusions: The new ISUP 2014 grading system is the most significant independent predictor for BCR, CP, and CRD. Grade group 3 and 4 had similar long-term disease progression survival rates and could potentially be stratified in the same risk group. High-risk cancer associated only with group 5.
Highlights
The Gleason score (GS) grading system is one of the strongest predictors for prostate cancer (PCa) outcomes and plays a significant role for choosing treatment modality
The division of GS into 6 vs. 7 vs. 8–10 together with corresponding grouping of the prostate specific antigen (PSA) and clinical stages into three groups—low, intermediate and high PCa risk groups,are known as D’Amico classification [3] that has been adopted in clinical practice and has been widely used for prognostic and therapeutic purposes
The primary end-point was to assess the association between the International Society of Urological Pathology (ISUP) 2014 grading and Biochemical progression free survival (BPFS); the secondary end-points were to investigate the association between the new grading system and clinical progression free survival (CPFS) and cancer specific survival (CSS)
Summary
The Gleason score (GS) grading system is one of the strongest predictors for prostate cancer (PCa) outcomes and plays a significant role for choosing treatment modality. Harrells’ c-index for the ISUP 2014 grading was significantly higher compared to the ISUP 2005 grading system [11] Such recent, new clinical data influenced the addition of ISUP grades 4 and 5 to the definition of high-risk PCa suggested by EAU [12]. The aim of the present study was to assess where the ISUP 2014 grading system reflects the recently proposed concept of high-risk PCa in a long-term follow-up cohort of men undergoing RP at a tertiary university hospital. The primary end-point was to assess the association between the ISUP 2014 grading and BPFS; the secondary end-points were to investigate the association between the new grading system and clinical progression free survival (CPFS) and cancer specific survival (CSS)
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