Impact of primary Gleason grade on risk stratification for Gleason score 7 prostate cancers.
OBJECTIVE
To evaluate the primary Gleason grade (GG) in Gleason score (GS) 7 prostate cancers for risk of non-organ-confined disease with the goal of optimizing radiotherapy treatment option counseling.


METHODS
One thousand three hundred thirty-three patients with pathologic GS7 were identified in the Duke Prostate Center research database. Clinical factors including age, race, clinical stage, prostate-specific antigen at diagnosis, and pathologic stage were obtained. Data were stratified by prostate-specific antigen and clinical stage at diagnosis into adapted D'Amico risk groups. Univariate and multivariate analyses were performed evaluating for association of primary GG with pathologic outcome.


RESULTS
Nine hundred seventy-nine patients had primary GG3 and 354 had GG4. On univariate analyses, GG4 was associated with an increased risk of non-organ-confined disease. On multivariate analysis, GG4 was independently associated with seminal vesicle invasion (SVI) but not extracapsular extension. Patients with otherwise low-risk disease and primary GG3 had a very low risk of SVI (4%).


CONCLUSIONS
Primary GG4 in GS7 cancers is associated with increased risk of SVI compared with primary GG3. Otherwise low-risk patients with GS 3+4 have a very low risk of SVI and may be candidates for prostate-only radiotherapy modalities.
Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC 27710, USA. bridget.koontz@duke.edu
Bridget F
BF
Koontz
Matvey
M
Tsivian
Vladimir
V
Mouraviev
Leon
L
Sun
Zeljko
Z
Vujaskovic
Judd
J
Moul
W Robert
WR
Lee
D000368:Aged; D000704:Analysis of Variance; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009929:Organ Size; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000208:ethnology / Q000473:pathology* / Q000532:radiotherapy; D012306:Risk; D012669:Seminal Vesicles / Q000473:pathology*
D017430:Prostate-Specific Antigen