MP15-20 10 YEARS LATER: IMPACT OF THE 2005 INTERNATIONAL SOCIETY OF UROLOGICAL PATHOLOGY GLEASON GRADING CONSENSUS ON THE SAFETY OF ACTIVE SURVEILLANCE.

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2016MP15-20 10 YEARS LATER: IMPACT OF THE 2005 INTERNATIONAL SOCIETY OF UROLOGICAL PATHOLOGY GLEASON GRADING CONSENSUS ON THE SAFETY OF ACTIVE SURVEILLANCE. Lukas Hefermehl and Kurt Lehmann Lukas HefermehlLukas Hefermehl More articles by this author and Kurt LehmannKurt Lehmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2544AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment decision for localized prostate cancer is mainly based on the Gleason score (GS). GS can show considerable discrepancy between needle biopsy (NB) and radical prostatectomy (RP). The 2005 International Society of Urological Pathology Gleason Grading Consensus concentrated its attention mainly on grade 3 & 4 and thereby on GS 6 & 7. One of the main goals was to improve concordance rates between NB and RP. For active surveillance (AS) this is of capital importance: There remains an uncertainty at time of NB whether or not the true GS would actually disqualify from AS. Objective was to determine if the new grading system has improved the concordance rates between NB and RP in the case of GS 6 & 7. METHODS Since 1999 we have an AS program at our institution, prospectively document all RP data and perform NB & RP in a standardized manner. We have compared GS of NB with GS after RP. We have chosen three periods: 1999-2005 (′old′ GS), 2006-07 (transitional period) & 2008-14 (′new′ GS). Because grade 3 & 4 have the highest impact on AS, we have focused on GS ≤7. RESULTS From 1999 to 2014 a total of 364 men after RP with a median age 63 (58-66) y and a median PSA of 5.9(4.3-8.3) ng/ml were analysed. A total of 230 men with GS ≤6 and 134 men with GS 7 were diagnosed by NB. Histology after RP revealed 160 cases with GS ≤6 and 204 with GS ≥7. The groups consisted of 195, 61 and 108 men for each time period (1999-2005; 2006-07; 2008-14). Median GS after RP was 6 in all groups. However, Kruskall Wallis analysis showed a significant lower grade (p=0.004) for the period 1999-2005. There was no difference in tumor diameter or T-stage. GS ≤6 in NB showed an up-grade in 44%, 42% & 46% (1999-2005; 2006-07 & 2008-14). For GS 7 an upgrade took place in 19%, 9% & 11%. Down-grade for GS 7 was shown in 11%, 4% & 2% only (for GS ≤6: 2%, 0% & 0%). CONCLUSIONS The modified Gleason grading led to a small shift towards higher GS. However, concordance rates between NB and RP did not improve. After RP an initially diagnosed GS =6 will still be up-graded in >40%. AS has not become safer by introducing the modified Gleason grading system. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e159 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Lukas Hefermehl More articles by this author Kurt Lehmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...