MP53-04 EFFECT OF TUMOR VOLUME AND PRESENCE OF GLEASON PATTERN 3 IN PROSTATE CANCER PATIENTS WITH GLEASON SCORE 8 ON PROSTATE NEEDLE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2018MP53-04 EFFECT OF TUMOR VOLUME AND PRESENCE OF GLEASON PATTERN 3 IN PROSTATE CANCER PATIENTS WITH GLEASON SCORE 8 ON PROSTATE NEEDLE BIOPSY Kevin Ginsburg, Michael Silverman, Joan Livingstone, Daryn Smith, Lance Heilbrun, and Michael Cher Kevin GinsburgKevin Ginsburg More articles by this author , Michael SilvermanMichael Silverman More articles by this author , Joan LivingstoneJoan Livingstone More articles by this author , Daryn SmithDaryn Smith More articles by this author , Lance HeilbrunLance Heilbrun More articles by this author , and Michael CherMichael Cher More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1675AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Commonly used risk stratification schemes assign risk based on the needle core with the highest Gleason Score (GS). This practice ignores the possibility that biopsy tumor volume (BTV) and tumor grade in other cores may affect outcomes. We sought to characterize the effect of BTV and the presence of Gleason pattern 3 on pathological outcomes in patients with the high-risk disease based on presence of GS 8 (4+4). METHODS This is a retrospective study of patients with Gleason 8 on prostate needle biopsy (PNB) from 2001 to 2015 at the Karmanos Cancer Institute. Patients were included if PNB demonstrated ≥ 1 core with only Gleason pattern 4 (8=4+4). Patients were labeled low volume GS 8 (LVGS8) if ≤ 2 cores were positive for GS 8 and ≤ 50% of the core was positive for GS 8 cancer. Otherwise, they were labeled high volume GS 8 (HVGS8). If PNB demonstrated only GS 8 (pattern 4), they were labeled pattern 4 only (PFO). If pattern 3 was noted in the other cores (GS 3+3, 3+4 or 4+3), they were labeled pattern 4 and 3 (PFAT). BTV and presence of pattern 3 were assessed separately and therefore, it was possible to be HVGS8 or LVGS8 and PFO or PFAT. Patients with PNB Gleason score ≥8 were excluded. RESULTS 96 patients met inclusion criteria of which 22 had pathologic Gleason score (pGS) based on radical prostatectomy (RP). Most patients with LVGS8 on biopsy had pGS=7 (11/13) compared to 5/9 patients with HVGS8. The pathologic primary pattern (pPP) in the RP specimen was Gleason pattern=3 (7/13) in LVGS8 while almost all HVGS8 were pPP=4 (8/9). No patients with LVGS8 (0/13) were pN1 while 3/9 HVGS8 patients were pN1. Over half of LVGS8 patients (8/13) had organ confined pT2 stage compared to 4/9 HVGS8 patients. Very few LVGS8 patients (3/49) were found to have metastasis on staging CT scan and bone scan compared to significantly higher proportion for HVGS8 (12/47), p=0.011. Patients with PFO (8/27) were more likely to have metastasis on staging evaluation than PFAT (7/68), p=0.041. CONCLUSIONS All patients with PNB GS8 are assigned to high-risk groups, though low GS8 tumor volume and the presence of pattern 3 in other cores suggests pathologic and staging outcomes more consistent with intermediate risk disease. Further studies into the effect of BTV and presence of lower grade disease in other cores in patients with GS 8 on PNB should be pursued. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e705 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kevin Ginsburg More articles by this author Michael Silverman More articles by this author Joan Livingstone More articles by this author Daryn Smith More articles by this author Lance Heilbrun More articles by this author Michael Cher More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...