PD08-12 PROGNOSTIC VALUE OF PERCENT GLEASON GRADE 4 IN PROSTATE BIOPSY SPECIMENS AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2016PD08-12 PROGNOSTIC VALUE OF PERCENT GLEASON GRADE 4 IN PROSTATE BIOPSY SPECIMENS AFTER RADICAL PROSTATECTOMY Adam Cole, Rohit Mehra, Daniel Spratt, Ganesh Palapattu, Chang He, Scott Tomlins, Alon Weizer, Angela Wu, Felix Fang, Jeffrey Montgomery, Lakshmi Kunju, David Miller, Brent Hollenbeck, John Wei, and Todd Morgan Adam ColeAdam Cole More articles by this author , Rohit MehraRohit Mehra More articles by this author , Daniel SprattDaniel Spratt More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , Chang HeChang He More articles by this author , Scott TomlinsScott Tomlins More articles by this author , Alon WeizerAlon Weizer More articles by this author , Angela WuAngela Wu More articles by this author , Felix FangFelix Fang More articles by this author , Jeffrey MontgomeryJeffrey Montgomery More articles by this author , Lakshmi KunjuLakshmi Kunju More articles by this author , David MillerDavid Miller More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , John WeiJohn Wei More articles by this author , and Todd MorganTodd Morgan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2828AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of primary Gleason grade among Gleason score 7 (3+4 vs 4+3) patients has significant impact on prognosis. However, this dichotomization negates the continuous spectrum of absolute percent Gleason grade 4 (G4%). Herein, we report the prognostic value of the G4%, a variable readily discernible from prostate biopsy reports, on cancer-related outcomes of men undergoing radical prostatectomy (RP). METHODS From 2005 - 2013, 1,691 consecutive patients underwent RP at a single institution for clinically localized prostate cancer. G4% was determined from prostate needle biopsies as total tumor length containing Gleason Pattern 4 divided by the total combined tumor length determined by an expert urologic pathologist. Time to biochemical recurrence (BCR), and the presence of adverse RP pathology, defined as primary Gleason 4 or ≥pT3, were correlated to G4% by multivariable logistic and Cox regression analyses. RESULTS Of the 1,691 patients, 517 (30.6%) had adverse pathological features, and 86 (5.6%) had a BCR. Median follow-up time was 1.7 years. Increasing G4% as a categorical variable was closely associated with both adverse pathology and BCR (Figure 1). On multivariable analyses, G4% was a significant predictor of adverse pathology (adjusted odds radio 1.04, 95% CI [1.03 - 1.05] for each 1% increase in G4%) and time to BCR (adjusted hazard ratio 1.02, 95% CI [1.01 - 1.03] for each 1% increase in G4%). G4% was also a significant predictor of adverse pathology in the Gleason 7 (adjusted OR 1.05, 95% CI [1.03 - 1.06]), 3+4 (adjusted OR 1.06, 95% CI: [1.04 - 1.08]), and 4+3 (adjusted OR 1.05, 95% CI [1.03 - 1.06]) subgroup analyses, and a significant predictor of BCR in the Gleason 7 subgroup (adjusted HR 1.02, 95% CI [1.00 - 1.04]). CONCLUSIONS The incremental percentage of Gleason grade 4 disease in prostate biopsy specimens is a significant risk factor for adverse pathology at time of surgery and BCR. Accounting for G4% can improve risk assessment even amongst Gleason 3+4 or Gleason 4+3 patients. Due to the ease of assessing this prognostic variable, G4% may add value in determining intermediate risk patients most ideal for active surveillance. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e233 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Adam Cole More articles by this author Rohit Mehra More articles by this author Daniel Spratt More articles by this author Ganesh Palapattu More articles by this author Chang He More articles by this author Scott Tomlins More articles by this author Alon Weizer More articles by this author Angela Wu More articles by this author Felix Fang More articles by this author Jeffrey Montgomery More articles by this author Lakshmi Kunju More articles by this author David Miller More articles by this author Brent Hollenbeck More articles by this author John Wei More articles by this author Todd Morgan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...