title: Risk stratification of men with Gleason score 7 to 10 tumors by primary and secondary Gleason score: results from the SEARCH database.
abstract: OBJECTIVE
  Gleason score 4+3 prostate cancer is associated with worse clinicopathologic outcomes than is Gleason score 3+4. Whether the increased risk associated with Gleason score 4+3 disease is equivalent to that of Gleason score 4+4 or greater is unclear.
  
  
  METHODS
  We reviewed the data from two separate cohorts pulled from the Shared Equal Access Regional Cancer Hospital database. The first consisted of 374 men with biopsy Gleason score 3+4 or greater disease and the second of 636 men with radical prostatectomy (RP) Gleason score 3+4 or greater disease. We estimated the odds ratios of unfavorable surgical pathologic findings for the biopsy Gleason score categories using logistic regression analysis. Using a Cox proportional hazards regression model, we estimated the relative risk of biochemical progression associated with each biopsy and RP Gleason score category.
  
  
  RESULTS
  In the biopsy Gleason score cohort, a Gleason score of 4+3 was associated with an increased risk of extracapsular extension (P = 0.01) and seminal vesicle invasion (P <0.001) relative to a biopsy Gleason score of 3+4. A biopsy Gleason score of 4+3 was associated with a similar risk of adverse pathologic findings relative to a biopsy Gleason score of 4+4 or greater (all P >0.10), except for higher grade pathologic tumors among men with a biopsy Gleason score of 4+4 or more (P = 0.001). After adjusting for multiple clinical characteristics, a biopsy Gleason score of 4+3 was associated with an increased recurrence risk relative to a biopsy Gleason score of 3+4 (P = 0.001), but a similar progression risk as that for a biopsy Gleason score of 4+4 or more (P = 0.53). In the RP Gleason cohort, and after adjustment for multiple clinicopathologic features, an RP Gleason score of 4+3 was associated with increased progression risk relative to an RP Gleason score of 3+4 (P = 0.03), but similar progression risk as that for an RP Gleason score of 4+4 or more (P = 0.24).
  
  
  CONCLUSIONS
  In a multicenter database using pooled data from multiple pathologists, Gleason scores 4+3 and 4+4 or more exhibited similar clinicopathologic outcomes.
authors.affiliation: Division of Urologic Surgery, Department of Surgery and Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kang
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Fitzsimons
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Presti
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D001706:Biopsy; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology*; D018570:Risk Assessment; D015996:Survival Rate