Prostate cancer outcomes of men with biopsy Gleason score 6 and 7 without cribriform or intraductal carcinoma

Kweldam, Charlotte F.; Kümmerlin, Intan P.E.D.; Nieboer, Daan; Verhoef, Esther I.; Steyerberg, E.W.; Incrocci, Luca; Bangma, Chris H.; Kwast, Theo H. van der; Roobol, Monique J.; Leenders, Geert J.L.H. van

doi:10.1016/s1569-9056(16)30441-9

Cited by 18 publications

(38 citation statements)

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“…Ill‐formed glands intermingled with bona‐fide pattern 3 glands should not, in their view, lead to an upgrading of the biopsy . Further studies on the three‐dimensional architecture and outcome of non‐cribriform Gleason score 3 + 4 = 7 compared to Gleason score 3 + 3 = 6 prostate cancer might reveal whether distinction of ill‐formed Gleason pattern 4 from Gleason pattern 3 is objectively feasible based on specific differences and are of clinical relevance …”

Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

“…However, it is still unclear how the prognostic impact of the ISUP grades would be mutually related if CR/IDC is incorporated. In a biopsy cohort it was shown that men with ISUP grade 2 without CR/IDC had similar biochemical recurrence rates and disease‐specific survival to men with ISUP grade 1 . This might imply that one point could be subtracted if CR/IDC is absent in ISUP grades 2–5.…”

Section: Future Implicationsmentioning

confidence: 99%

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Grading of prostate cancer: a work in progress

2018

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Grading of prostate cancer has evolved substantially over time, not least because of major changes in diagnostic approach and concomitant shifts from late‐ to early‐stage detection since the adoption of PSA testing from the late 1980s. After the conception of the architecture‐based nine‐tier Gleason grading system more than 50 years ago, several changes were made in order to increase its prognostic impact, to reduce interobserver variation and to improve concordance between prostate needle biopsy and radical prostatectomy grading. This eventually resulted in the current five‐tier grading system, with a much more detailed description of the individual architectural patterns constituting the remaining three Gleason patterns (i.e. grades 3–5). Nevertheless, there is room for improvement. For instance, distinction of common grade 4 subpatterns such as ill‐formed and fused glands from the grade 3 pattern is challenging, blurring the division between low‐risk patients who could be eligible for deferred therapy and those who need curative therapy. The last few years have witnessed the publication of several studies on the prognostic impact of individual architectural subpatterns showing that, in particular, the cribriform pattern exceeded the prognostic impact of other grade 4 subpatterns. This review provides an overview of the changes in prostate cancer grading over time and provides a thorough description of the various Gleason subpatterns, the current evidence of their prognostic impact and areas of contention. Potential practical ways for improvements of the current grading system are also put forward.

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Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

Section: Future Implicationsmentioning

confidence: 99%

Grading of prostate cancer: a work in progress

2018

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“…It is acknowledged increasingly that histopathological parameters beyond GS such as percentage Gleason grade 4, the presence of invasive cribriform growth or intraductal carcinoma contribute significantly to risk stratification. For instance, men with non‐cribriform GS 3 + 4 = 7 have similar BCRFS and DSS to those with biopsy GS 6, while patients with cribriform GS 3 + 4 = 7 behave significantly worse . To support optimal individual decision‐making it is important that these pathological parameters are reported routinely and included in risk stratification models.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, men with non-cribriform GS 3 + 4 = 7 have similar BCRFS and DSS to those with biopsy GS 6, while patients with cribriform GS 3 + 4 = 7 behave significantly worse. 10,11 To support optimal individual decision-making it is important that these pathological parameters are reported routinely and included in risk stratification models.…”

Section: Discussionmentioning

confidence: 99%

“…reviewed all prostate biopsies taken between November 1993 and March 2000 according to WHO/ISUP 2014 guidelines. 1,2,10,11 Cases were excluded when no slides were present for review or when metastasis was present at time of diagnosis. For each biopsy core GS, percentage tumour involvement, the presence of invasive cribriform or intraductal carcinoma (CR/IDC) and percentage Gleason 4 was recorded.…”

Section: P a T I E N T S E L E C T I O Nmentioning

confidence: 99%

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Characteristics and outcome of prostate cancer patients with overall biopsy Gleason score 3 + 4 = 7 and highest Gleason score 3 + 4 = 7 or > 3 + 4 = 7

et al. 2018

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The highest percentage of Gleason Pattern 4 is a predictor in intermediate‐risk prostate cancer

et al. 2022

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Objectives: This study aims to clarify the clinicopathological significance of several novel pathological markers, including the percentage of Gleason pattern 4 and small/ non-small cribriform pattern, in intermediate-risk Gleason score 3 + 4 = 7 prostate cancer. Subjects and Methods: Two-hundred and twenty-eight patients with Gleason score 3 + 4 = 7 intermediate-risk prostate cancer who underwent radical prostatectomy between 2009 and 2019 at our institute were selected. Preoperative clinicopathological characteristics, including serum prostate-specific antigen level, clinical T stage, percentage of cancer-positive cores at biopsy, small/non-small cribriform pattern, the highest percentage of Gleason pattern 4, the total length of Gleason pattern 4 and percentage of Gleason score 7 cores were examined in univariate/multivariate logistic regression analysis to determine their predictive value for postoperative adverse pathological findings, defined as an upgrade to Gleason score 4 + 3 = 7 or higher, pN1 or pT3b disease.Results: Fifty-four cases (23.7%) showed adverse pathological findings. Although a non-small cribriform pattern, highest Gleason pattern 4 percentage and total length of Gleason pattern 4 were predictive of adverse pathological findings in univariate analysis, only the highest Gleason pattern 4 percentage was an independent predictive factor in multivariate analysis (odds ratio: 1.610; 95% confidence interval:1.260-2.070; P = 0.0002). Conclusion:The highest Gleason pattern 4 percentage was a potent predictive parameter for Gleason score 3 + 4 = 7 intermediate-risk prostate cancer and should be considered in the risk classification scheme for prostate cancer.

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Prostate cancer outcomes of men with biopsy Gleason score 6 and 7 without cribriform or intraductal carcinoma

Cited by 18 publications

References 0 publications

Grading of prostate cancer: a work in progress

Grading of prostate cancer: a work in progress

Characteristics and outcome of prostate cancer patients with overall biopsy Gleason score 3 + 4 = 7 and highest Gleason score 3 + 4 = 7 or > 3 + 4 = 7

The highest percentage of Gleason Pattern 4 is a predictor in intermediate‐risk prostate cancer

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