Abstract
The aim of this study was to compare the prognosis of Gleason Score (GS) 7 (3+4) prostatic adenocarcinoma with a low percentage of grade 4 to that of GS6 (3+3) prostatic adenocarcinoma. All patients with GS6 or GS7 prostatic adenocarcinoma who underwent prostatectomy between 2014 and 2018 were selected. The prostate biopsy (PB) and prostatectomy resection specimen (RS) slides were reviewed by 2 pathologists. A statistical analysis was carried out to evaluate the relationship between the clinical, paraclinical and histological characteristics of the patients on biopsies and prostatectomies with the risk of recurrence. One hundred and four patients were included. A recurrence occurred in 21 patients (20.2%). In univariate analysis, an association was observed between the risk of recurrence and the GS (P=0.014 for PB / P=0.006 for RS), grade 4 percentage (P=0.020/P=0.002), especially by applying the thresholds of 5% (P=0.008/P=0.018) and 10% (P=0.015/P<0.001), the tumor stage pT (P=0.045), the quality of surgical resection R (P=0.015) and the size of the tumor focus in contact with the limits (P<0.001). In multivariate analysis, grade 4 percentage greater than 10% was associated with the risk of recurrence on biopsy and prostatectomy (respectively OR 4.83 [IC95 1.38; 16.88]; P=0.014 and OR 6.29 [IC95 1.96; 20.20]; P=0.002), as well as R1 resection (OR 3.65 [IC95 1.24; 10.76]; P=0.019 and OR 4.06 [IC95 1.27; 13.03]; P=0.018). Our study suggests that GS7 (3+4) tumors with less than 10% of grade 4 have a similar prognosis to that of GS6 (3+3) tumors. This could allow some GS7 (3+4) patients to benefit from the active surveillance therapy, instead of undergoing more aggressive treatments such as surgery or radiotherapy.
Published Version
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