title: Differences in histopathological and biochemical outcomes in patients with low Gleason score prostate cancer.
abstract: METHODS
  Diagnosis (case series).
  
  
  METHODS
  4.
  
  
  OBJECTIVE
  To test whether the number or percentage of positive biopsy cores can be used to discriminate between patients with prostate cancer of a favourable and less favourable Gleason score (GS) < or =3 + 3, as prognostically, not all GS 3 + 3 prostate cancers are the same.
  
  
  METHODS
  In all, 1106 consecutive patients with a prostate-specific antigen (PSA) level of < or =10 ng/mL and a biopsy GS of < or =3 + 3 or 3 + 4 had an open radical prostatectomy. The number of positive biopsy cores (< or =2 vs > or =3) were stratified into low- vs high-risk groups. Subsequently, we stratified patients according to the GS and the percentage of positive biopsy cores (<50% vs > or =50%). The pathological stage and the 5-year biochemical recurrence (BCR)-free survival rates were examined in univariable and multivariable models.
  
  
  RESULTS
  Based on the number of positive cores, the rate of extraprostatic disease was 11.7% and 23.3%, respectively, in the low-and high-risk GS < or =3 + 3 groups (P < 0.001). The 5-year BCR-free survival rates were 95.0%, 77.8%, 81.2% and 66.5% for, respectively, low- and high-risk GS < or =3 + 3 and for low- and high-risk GS 3 + 4 patients. Univariable and multivariable intergroup BCR rate differences were statistically significant between low- vs high-risk GS 3 + 3 patients (P < 0.001), but not significant between high-risk GS < or =3 + 3 vs low-risk GS 3 + 4 patients (P = 0.6). Comparable results were obtained when comparisons were made according to the percentage of positive biopsy cores.
  
  
  CONCLUSIONS
  Our results corroborate the finding that not all patients with a biopsy GS of < or =3 + 3 prostate cancer have low-risk disease. High-risk GS < or =3 + 3 patients have a similar risk profile as more favourable GS 3 + 4 patients. This finding warrants consideration when deciding on treatment.
authors.affiliation: Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. hendrikisbarn@gmail.com
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Ahyai
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Mario
authors.initials: M
authors.lastname: Zacharias
authors.forename: Roman
authors.initials: R
authors.lastname: Heuer
authors.forename: Christian
authors.initials: C
authors.lastname: Eichelberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Lars
authors.initials: L
authors.lastname: Budäus
authors.forename: Jens
authors.initials: J
authors.lastname: Köllermann
authors.forename: Georg
authors.initials: G
authors.lastname: Salomon
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen