You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2016PD42-12 EXTRA-PROSTATIC EXTENSION AND SEMINAL VESICLE INVASION ARE EXCEEDINGLY RARE AT RADICAL PROSTATECTOMY FOR GLEASON 6 PROSTATE CANCER USING ISUP MODIFIED SCORING CRITERIA Blake Anderson, Aria Razmaria, Bonnie Choy, Gregory Zagaja, Arieh Shalhav, Gladell Paner, and Scott Eggener Blake AndersonBlake Anderson More articles by this author , Aria RazmariaAria Razmaria More articles by this author , Bonnie ChoyBonnie Choy More articles by this author , Gregory ZagajaGregory Zagaja More articles by this author , Arieh ShalhavArieh Shalhav More articles by this author , Gladell PanerGladell Paner More articles by this author , and Scott EggenerScott Eggener More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1764AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies employing contemporary Gleason grading have demonstrated Gleason score 6 (GS6) prostate cancers lack the ability to metastasize. The goal of this study was to assess the pathologic stage following radical prostatectomy of true GS6 prostate cancers in a large institutional series. METHODS From 2003 to 2013, 3731 patients underwent robotic radical prostatectomy at a single academic institution. Out of 1106 patients with GS6 identified at surgery, 38 (3.4%) were identified as GS6 with stage pT3a/b on initial pathologic review, 34 with pT3a (extra-prostatic extension; EPE) and 4 with pT3b disease (seminal vesicle invasion; SVI). All cases underwent repeat pathologic evaluation by a single expert genitourinary pathologist (GPP) for Gleason grade, pathological stage, extent of EPE, percent of prostate volume with tumor, percent of Gleason pattern 4 and type of Gleason pattern 4 (e.g. cribriform, fused, ill-formed, glomeruloid, variant patterns). Additionally, all Gleason score 7-9 (GS7-9) pT3b cases from our database, in total 153, were re-reviewed. The 2014 International Society of Urological Pathology (ISUP) modified Gleason grading criteria were applied. RESULTS Of the 38 GS6 pT3a/b cases, 34 (90%) were upgraded to Gleason 3+4 (32), 4+3 (1) or 4+4 (1). Of the upgraded cases, 8 (24%) had minor (< 5%) components of pattern 4, which under the 2004 ISUP Gleason grading consensus was not established as a secondary grade. Six (16%) were down-staged to pT2 since only capsular incision was present or tumor invaded capsule but not beyond. After re-review, only 2 cases (0.2% of entire GS6 cohort) with pT3a were observed, both with focal EPE (non-established). Among the re-examined cohort, no cases with pure GS6 and stage pT3b were observed. Ill-formed glands were the most common type of pattern 4 present in 91% of upgraded cases, followed by fused (82%) and cribriform (35%) glands. Ductal (6%) and mucinous (3%) variants were rare reasons for upgrading. Lastly, none of the 153 GS7-9 pT3b cases were downgraded to Gleason 6. CONCLUSIONS In this large contemporary study, Gleason 6 prostate cancer never had seminal vesicle invasion (0%) and was only rarely (0.2%) associated with extra-prostatic extension. Our data further supports active surveillance as an optimal management strategy for most men with Gleason 6 prostate cancer. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e992 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Blake Anderson More articles by this author Aria Razmaria More articles by this author Bonnie Choy More articles by this author Gregory Zagaja More articles by this author Arieh Shalhav More articles by this author Gladell Paner More articles by this author Scott Eggener More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...