Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy

Abstract

Background The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component. Objective We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease. Design, setting, and participants We analyzed a cohort of 2630 radical prostatectomy cases from 1990–2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion. Outcome measurements and statistical analysis Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis. Results and limitations qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell’s c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82). Conclusions Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score. Patient summary In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.

Prostate cancer grading: a decade after the 2005 modified system

“…Subsequent to the 2014 Consensus Conference, studies have demonstrated that increasing percent pattern 4 at RP correlates with an increased risk of biochemical recurrence after RP. 42,50,51 There have also been several publications showing that percent pattern 4 on needle biopsy can improve prediction of upgrading at RP and of adverse findings at RP and biochemical recurrence after RP. 52,53 General applications of the Gleason grading system…”

Up‐regulation of LIMK1 expression in prostate cancer is correlated with poor pathological features, lymph node metastases and biochemical recurrence

“…At present, there are many clinicopathological parameters to evaluate the risk of progression, metastasis and prognosis of PCa. The risk factors for biochemical recurrence included body mass index, preoperative PSA, the proportion of positive biopsy cores, pathological stage, extracapsular extension, seminal vesical invasion, lymph node metastasis, and positive surgical margin . However, the accuracy of these traditional clinicopathological factors for predicting the biochemical recurrence of PCa remains low .…”

Prostate Cancers Detected by Magnetic Resonance Imaging–Targeted Biopsies Have a Higher Percentage of Gleason Pattern 4 Component and Are Less Likely to Be Upgraded in Radical Prostatectomies

“…Studies have shown that the quantity of GP 4/5 provides additional prognostic significance. [6][7][8][9][10] Cole et al 10 reported that the incremental percent of GP 4 component in biopsies was an important predictor of adverse pathology and prostate-specific antigen recurrence across the entire range of GS 3 þ 4, 4 þ 3, and 4 þ 4 PCa. The quantity of GP 4 has been used in determining candidacy for active surveillance and for selection of different radiation therapy protocols.…”

“…There have been continued efforts in improving the Gleason system for risk stratification. 9 Permutations of the Gleason system have been exploited to enhance risk stratification, such as quantification of Gleason grade 4/ 5. [11][12][13][14][15] Several recent studies show that cribriform pattern is the worst of all GP 4 morphologies (others being poorly formed glands and fused glands) and independently predicts biochemical recurrence and risk of distant metastasis.…”

“…[1][2][3][4][5] Studies further demonstrated that quantification of high-grade component (GP 4/5) provides additional prognostic significance. [6][7][8][9][10] Recent studies have also shown that GS 7 PCa with minor GP 4 component has similar pathologic features and clinical outcomes as GS 6 PCa. A GS 7 PCa with 5% or less GP 4 and GS 6 PCa diagnosed on biopsy has similar pathological findings at RP.…”