Prognosis of Gleason Score 9–10 Prostatic Adenocarcinoma in Needle Biopsies: A Nationwide Population-based Study

Abstract

BackgroundSince 2014, prostate cancer is reported using five-tier grouping of Gleason scores. Studies have suggested prognostic heterogeneity within the groups. ObjectiveWe assessed the risk of prostate cancer death for men diagnosed with Gleason scores 4 + 5, 5 + 4, and 5 + 5 on needle biopsy in a population-based cohort. Design, setting, and participantsWe used the data from Prostate Cancer data Base Sweden (PCBaSe) 4.0 for a survival analysis. Among 199 620 men reported to have prostate cancer in 2000–2020, 172 112 were diagnosed on needle biopsy. The primary treatment was classified as androgen deprivation therapy (66%), deferred treatment (5%), radical prostatectomy (7%), or radical radiotherapy (21%). Outcome measurements and statistical analysisThe risks of death from prostate cancer in men with Gleason score 9–10 at 5 and 10 yr were used as endpoints. Multivariable Cox regression models controlling for socioeconomic factors and primary treatment were used for time-to-event analyses of death from prostate cancer and death from any causes. Results and limitationsA total of 20 419 (12%) men had a Gleason score of 9–10, including Gleason scores of 4 + 5, 5 + 4, and 5 + 5 in 14 333 (70%), 4223 (21%), and 1863 (9%) men, respectively. The risks of prostate cancer death for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr of follow-up were 0.45 (confidence interval [CI] 0.44–0.46), 0.56 (0.55–0.58), and 0.66 (0.63–0.68), respectively. The risks of death of any cause for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr were 0.73 (CI 0.72–0.74), 0.81 (0.80–0.83), and 0.87 (0.85–0.89), respectively. ConclusionsWe demonstrate in the largest and most complete cohort analyzed to date that collapsing the Gleason scores by grouping results in loss of prognostic information in men with Gleason score 9–10 cancer. Patient summarySurvival of prostate cancer patients with the highest tumor grades varies depending on grade composition.