Differences in histopathological and biochemical outcomes in patients with low Gleason score prostate cancer.
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.
Isbarn
Hendrik
H
Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. hendrikisbarn@gmail.com
Karakiewicz
Pierre I
PI
Ahyai
Sascha A
SA
Chun
Felix K H
FK
Jeldres
Claudio
C
Haese
Alexander
A
Heinzer
Hans
H
Zacharias
Mario
M
Heuer
Roman
R
Eichelberg
Christian
C
Steuber
Thomas
T
Budäus
Lars
L
Köllermann
Jens
J
Salomon
Georg
G
Schlomm
Thorsten
T
Perrotte
Paul
P
Fisch
Margit
M
Huland
Hartwig
H
Graefen
Markus
M
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
D017430:Prostate-Specific Antigen