MP53-17 CLINICAL VALIDATION OF THE 2005 ISUP GLEASON GRADING SYSTEM IN A COHORT OF INTERMEDIATE AND HIGH RISK MEN UNDERGOING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2015MP53-17 CLINICAL VALIDATION OF THE 2005 ISUP GLEASON GRADING SYSTEM IN A COHORT OF INTERMEDIATE AND HIGH RISK MEN UNDERGOING RADICAL PROSTATECTOMY Ashley Ross, Stephania Bezerra, Sheila Faraj, Kasra Yousefi, Helen Fedor, Stephanie Glavaris, Misop Han, Alan Partin, Elizabeth Humphreys, Jeffrey Tosoian, Michael H. Johnson, Elai Davicioni, Bruce Trock, Edward Schaeffer, and George Netto Ashley RossAshley Ross More articles by this author , Stephania BezerraStephania Bezerra More articles by this author , Sheila FarajSheila Faraj More articles by this author , Kasra YousefiKasra Yousefi More articles by this author , Helen FedorHelen Fedor More articles by this author , Stephanie GlavarisStephanie Glavaris More articles by this author , Misop HanMisop Han More articles by this author , Alan PartinAlan Partin More articles by this author , Elizabeth HumphreysElizabeth Humphreys More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Michael H. JohnsonMichael H. Johnson More articles by this author , Elai DavicioniElai Davicioni More articles by this author , Bruce TrockBruce Trock More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and George NettoGeorge Netto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1711AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2005, the International Society of Urological Pathology (ISUP) introduced several modifications aimed at improving the prognostic ability of the Gleason grading system for prostatic carcinoma. We sought to clinically validate the updated Gleason score in a natural history cohort of intermediate and high risk men who underwent radical prostatectomy (RP). METHODS In an IRB-approved study, we queried our institutional database for men with NCCN clinically localized intermediate to high risk prostate cancer who underwent RP during the PSA era. A case-cohort design was utilized, and the primary outcome was metastatic progression. The study cohort included men with complete pathological data and complete clinical follow-up who did not undergo additional treatment prior to the study endpoint. All prostatectomy specimens were re-reviewed by a urologic pathologist blinded to clinical outcome, and Gleason scores were reassigned per the 2005 ISUP system. The association of Gleason score with metastatic disease was assessed using Cox proportional hazards models, and prognostic ability was compared between the original and updated Gleason grading systems. RESULTS At the time of analysis, 260 men met all study criteria. Over median follow-up of 10 years, 99 (38.1%) men subsequently developed metastasis and 161 (61.9%) did not. Men with metastasis were more frequently upgraded (≥ 1-point rise in Gleason score) using the ISUP 2005 criteria than men who did not develop metastasis (30% vs 7%, respectively p<0.001). Using the original Gleason grading system and Gleason score 7 as reference, the presence of Gleason sum 8 or 9 cancer was associated with an increased hazard of metastasis (HR 2.0, 95% CI 1.1-3.7, p=0.03 and HR 6.1, 95% CI 3.4-10.9, p<0.001, respectively). After re-review using the updated 2005 ISUP grading system, the hazard ratios for metastasis increased to 2.4 (95% CI 1.1-5.4, p=0.03) and 9.8 (95% CI: 5.8-16.8, p<0.001) for Gleason score 8 and 9, respectively. In accordance with this, the c-index of Gleason score for metastasis-free survival 5 years after RP increased from 0.70 (95% CI: 0.61-0.79) to 0.82 (95% CI: 0.74-0.88) when samples were re-graded by the 2005 ISUP criteria. CONCLUSIONS Here we present the first clinical validation of the ISUP 2005 criteria in a natural history cohort of at-risk men who underwent RP. Indeed, use of the updated Gleason grading system significantly improves the prognostic ability of Gleason score for subsequent metastatic disease. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e642 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley Ross More articles by this author Stephania Bezerra More articles by this author Sheila Faraj More articles by this author Kasra Yousefi More articles by this author Helen Fedor More articles by this author Stephanie Glavaris More articles by this author Misop Han More articles by this author Alan Partin More articles by this author Elizabeth Humphreys More articles by this author Jeffrey Tosoian More articles by this author Michael H. Johnson More articles by this author Elai Davicioni More articles by this author Bruce Trock More articles by this author Edward Schaeffer More articles by this author George Netto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...