Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4 + 4 = 8

Nicholas Harding-Jackson, Oleksandr Kryvenko, Elizabeth E. Whittington, Daniel C. Eastwood, George A. Tjionas, Merce Jorda, Kenneth A. Iczkowski

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose ISUP (International Society for Urologic Pathology) and WHO adopted prognostic Grade Groups 1 to 5 that simplify prostate cancer grading for prognosis. Grade Group 4 is Gleason score 8 cancer, which is heterogeneous, and it encompasses Gleason score 4 + 4 = 8, 3 + 5 = 8 and 5 + 3 = 8. The comparative prognostic implications of these various Gleason scores had not been studied by urological pathologists after a re-review of slides. Materials and Methods Patients with a highest biopsy Gleason score of 3 + 5 = 8 or 4 + 4 = 8 were included in the study. Controls were cases with a highest Gleason score of 4 + 3 = 7 or 9-10. A total of 423 prostatic biopsy cases accessioned from 2005 to 2013 at 2 institutions were reviewed. Clinicopathological findings and followup (median 33.4 months) were assessed. Results Among Gleason score 8 cancers the cancer status outcome in 51 men with Gleason score 3 + 5 = 8 was marginally worse than in 114 with Gleason score 4 + 4 = 8 (p = 0.04). This was driven by a persistent nonmetastatic (after radiation/hormone therapy) cancer rate of 37% among Gleason score 3 + 5 = 8 cases vs 24% among Gleason score 4 + 4 = 8 cases. Conversely, cancer specific survival at 36-month followup was 97.8% in 3 + 5 cases vs 92.6% in 4 + 4 cases but this was not significant (p = 0.089). Cancer specific survival in the Gleason score 8 group was dichotomized by the presence of cribriform growth (p = 0.018). All Gleason score categories did not differ in the fraction of biopsy cores positive, clinical presentation or pathological findings, including the frequency of Gleason pattern 5, in 70 patients who underwent prostatectomy. Conclusions Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 = 8 and 4 + 4 = 8 cancers. This justifies including both in Grade Group 4.

Original languageEnglish (US)
Pages (from-to)1076-1081
Number of pages6
JournalJournal of Urology
Volume196
Issue number4
DOIs
StatePublished - Oct 1 2016

Fingerprint

Neoplasm Grading
Needle Biopsy
Prostatic Neoplasms
Neoplasms
Biopsy
Survival
Prostatectomy
Radiotherapy

Keywords

  • biopsy
  • neoplasm grading
  • neoplasm recurrence, local
  • prostatic neoplasms
  • World Health Organization

ASJC Scopus subject areas

  • Urology

Cite this

Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy : Prognostic Comparison with Gleason 4 + 4 = 8. / Harding-Jackson, Nicholas; Kryvenko, Oleksandr; Whittington, Elizabeth E.; Eastwood, Daniel C.; Tjionas, George A.; Jorda, Merce; Iczkowski, Kenneth A.

In: Journal of Urology, Vol. 196, No. 4, 01.10.2016, p. 1076-1081.

Research output: Contribution to journalArticle

Harding-Jackson, Nicholas ; Kryvenko, Oleksandr ; Whittington, Elizabeth E. ; Eastwood, Daniel C. ; Tjionas, George A. ; Jorda, Merce ; Iczkowski, Kenneth A. / Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy : Prognostic Comparison with Gleason 4 + 4 = 8. In: Journal of Urology. 2016 ; Vol. 196, No. 4. pp. 1076-1081.
@article{c188ea5106554d97ad360a95933666ff,
title = "Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4 + 4 = 8",
abstract = "Purpose ISUP (International Society for Urologic Pathology) and WHO adopted prognostic Grade Groups 1 to 5 that simplify prostate cancer grading for prognosis. Grade Group 4 is Gleason score 8 cancer, which is heterogeneous, and it encompasses Gleason score 4 + 4 = 8, 3 + 5 = 8 and 5 + 3 = 8. The comparative prognostic implications of these various Gleason scores had not been studied by urological pathologists after a re-review of slides. Materials and Methods Patients with a highest biopsy Gleason score of 3 + 5 = 8 or 4 + 4 = 8 were included in the study. Controls were cases with a highest Gleason score of 4 + 3 = 7 or 9-10. A total of 423 prostatic biopsy cases accessioned from 2005 to 2013 at 2 institutions were reviewed. Clinicopathological findings and followup (median 33.4 months) were assessed. Results Among Gleason score 8 cancers the cancer status outcome in 51 men with Gleason score 3 + 5 = 8 was marginally worse than in 114 with Gleason score 4 + 4 = 8 (p = 0.04). This was driven by a persistent nonmetastatic (after radiation/hormone therapy) cancer rate of 37{\%} among Gleason score 3 + 5 = 8 cases vs 24{\%} among Gleason score 4 + 4 = 8 cases. Conversely, cancer specific survival at 36-month followup was 97.8{\%} in 3 + 5 cases vs 92.6{\%} in 4 + 4 cases but this was not significant (p = 0.089). Cancer specific survival in the Gleason score 8 group was dichotomized by the presence of cribriform growth (p = 0.018). All Gleason score categories did not differ in the fraction of biopsy cores positive, clinical presentation or pathological findings, including the frequency of Gleason pattern 5, in 70 patients who underwent prostatectomy. Conclusions Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 = 8 and 4 + 4 = 8 cancers. This justifies including both in Grade Group 4.",
keywords = "biopsy, neoplasm grading, neoplasm recurrence, local, prostatic neoplasms, World Health Organization",
author = "Nicholas Harding-Jackson and Oleksandr Kryvenko and Whittington, {Elizabeth E.} and Eastwood, {Daniel C.} and Tjionas, {George A.} and Merce Jorda and Iczkowski, {Kenneth A.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.juro.2016.05.105",
language = "English (US)",
volume = "196",
pages = "1076--1081",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy

T2 - Prognostic Comparison with Gleason 4 + 4 = 8

AU - Harding-Jackson, Nicholas

AU - Kryvenko, Oleksandr

AU - Whittington, Elizabeth E.

AU - Eastwood, Daniel C.

AU - Tjionas, George A.

AU - Jorda, Merce

AU - Iczkowski, Kenneth A.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose ISUP (International Society for Urologic Pathology) and WHO adopted prognostic Grade Groups 1 to 5 that simplify prostate cancer grading for prognosis. Grade Group 4 is Gleason score 8 cancer, which is heterogeneous, and it encompasses Gleason score 4 + 4 = 8, 3 + 5 = 8 and 5 + 3 = 8. The comparative prognostic implications of these various Gleason scores had not been studied by urological pathologists after a re-review of slides. Materials and Methods Patients with a highest biopsy Gleason score of 3 + 5 = 8 or 4 + 4 = 8 were included in the study. Controls were cases with a highest Gleason score of 4 + 3 = 7 or 9-10. A total of 423 prostatic biopsy cases accessioned from 2005 to 2013 at 2 institutions were reviewed. Clinicopathological findings and followup (median 33.4 months) were assessed. Results Among Gleason score 8 cancers the cancer status outcome in 51 men with Gleason score 3 + 5 = 8 was marginally worse than in 114 with Gleason score 4 + 4 = 8 (p = 0.04). This was driven by a persistent nonmetastatic (after radiation/hormone therapy) cancer rate of 37% among Gleason score 3 + 5 = 8 cases vs 24% among Gleason score 4 + 4 = 8 cases. Conversely, cancer specific survival at 36-month followup was 97.8% in 3 + 5 cases vs 92.6% in 4 + 4 cases but this was not significant (p = 0.089). Cancer specific survival in the Gleason score 8 group was dichotomized by the presence of cribriform growth (p = 0.018). All Gleason score categories did not differ in the fraction of biopsy cores positive, clinical presentation or pathological findings, including the frequency of Gleason pattern 5, in 70 patients who underwent prostatectomy. Conclusions Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 = 8 and 4 + 4 = 8 cancers. This justifies including both in Grade Group 4.

AB - Purpose ISUP (International Society for Urologic Pathology) and WHO adopted prognostic Grade Groups 1 to 5 that simplify prostate cancer grading for prognosis. Grade Group 4 is Gleason score 8 cancer, which is heterogeneous, and it encompasses Gleason score 4 + 4 = 8, 3 + 5 = 8 and 5 + 3 = 8. The comparative prognostic implications of these various Gleason scores had not been studied by urological pathologists after a re-review of slides. Materials and Methods Patients with a highest biopsy Gleason score of 3 + 5 = 8 or 4 + 4 = 8 were included in the study. Controls were cases with a highest Gleason score of 4 + 3 = 7 or 9-10. A total of 423 prostatic biopsy cases accessioned from 2005 to 2013 at 2 institutions were reviewed. Clinicopathological findings and followup (median 33.4 months) were assessed. Results Among Gleason score 8 cancers the cancer status outcome in 51 men with Gleason score 3 + 5 = 8 was marginally worse than in 114 with Gleason score 4 + 4 = 8 (p = 0.04). This was driven by a persistent nonmetastatic (after radiation/hormone therapy) cancer rate of 37% among Gleason score 3 + 5 = 8 cases vs 24% among Gleason score 4 + 4 = 8 cases. Conversely, cancer specific survival at 36-month followup was 97.8% in 3 + 5 cases vs 92.6% in 4 + 4 cases but this was not significant (p = 0.089). Cancer specific survival in the Gleason score 8 group was dichotomized by the presence of cribriform growth (p = 0.018). All Gleason score categories did not differ in the fraction of biopsy cores positive, clinical presentation or pathological findings, including the frequency of Gleason pattern 5, in 70 patients who underwent prostatectomy. Conclusions Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 = 8 and 4 + 4 = 8 cancers. This justifies including both in Grade Group 4.

KW - biopsy

KW - neoplasm grading

KW - neoplasm recurrence, local

KW - prostatic neoplasms

KW - World Health Organization

UR - http://www.scopus.com/inward/record.url?scp=84992707548&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992707548&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2016.05.105

DO - 10.1016/j.juro.2016.05.105

M3 - Article

C2 - 27265220

AN - SCOPUS:84992707548

VL - 196

SP - 1076

EP - 1081

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 4

ER -