Prognostic Significance of the New Prostatic Carcinoma Grade Grouping System vis-à-vis Biochemical Recurrence: Experience from a Tertiary Care Centre in Dakshina Kannada District, Karnataka, India

Abstract

Introduction: Prostate cancer is the second leading malignancy in males worldwide with a similar preponderance seen in India. Universally, Prostate Specific Antigen (PSA) is a widely utilised resourceful screening and prognostic marker; however, few patients still present this in advanced stage. Hence, it is crucial to recognise the risk groups with utility of different prognostic parameters like Gleason grade grouping apart from PSA level. Studies have validated the Grade Group (GG) is a prognostic marker for Biochemical Recurrence (BR) as well as disease- specific death of patients. Aim: To assess the usefulness of the new prostatic GG system as compared to the earlier Gleasons scoring system in prognostication with the post-therapy PSA levels being utilised as evidence of BR. Materials and Methods: This was a retrospective study conducted on cases received over a duration of three years from January 2017 to December 2019 in the Department of Pathology Yenepoya Medical College, Mangalore. All the prostatic carcinoma slides were reviewed and reported by histopathologists according to modified grade grouping system and College of American Pathologists protocol. All parameters were analysed in SPSS software version 23. Results: A total of 72 cases (23 prostatectomy and 49 biopsy samples) were included. Majority of prostatectomy cases presented in T3b TNM stage and showed perineural invasion. Significant relationship was found between old Gleason’s Scoring (GS) system and new grade grouping with p-value of <0.05. Regression analysis reveals new GG is 15 times better than old GS reporting. Conclusion: The new grade grouping of prostatic adenocarcinoma is better than GS system in prognostication and compares well with TNM staging and perineural invasion.