The effect of differing Gleason scores at biopsy on the odds of upgrading and the risk of death from prostate cancer.
BACKGROUND
The GS is an established prostate cancer prognostic factor. Whether the presence of differing GSs at biopsy (eg, 4+3 and 3+3), which we term ComboGS, improves the prognosis that would be predicted based on the highest GS (eg, 4+3) because of decreased upgrading is unknown. Therefore, we evaluated the odds of upgrading at time of radical prostatectomy (RP) and the risk of PCSM when ComboGS was present versus absent.


METHODS
Logistic and competing risks regression were performed to assess the effect that ComboGS had on the odds of upgrading at time of RP in the index (n = 134) and validation cohorts (n = 356) and the risk of PCSM after definitive therapy in a long-term cohort (n = 666), adjusting for known predictors of these end points. We calculated and compared the area under the curve using a receiver operating characteristic analysis when ComboGS was included versus excluded from the upgrading models.


RESULTS
ComboGS was associated with decreased odds of upgrading (index: adjusted odds ratio [AOR], 0.14; 95% confidence interval [CI], 0.04-0.50; P = .003; validation: AOR, 0.24; 95% CI, 0.11-0.51; P < .001) and added significantly to the predictive value of upgrading for the in-sample index (P = .02), validation (P = .003), and out-of-sample prediction models (P = .002). ComboGS was also associated with a decreased risk of PCSM (adjusted hazard ratio, 0.40; 95% CI, 0.19-0.85; P = .02).


CONCLUSIONS
Differing biopsy GSs are associated with a lower odds of upgrading and risk of PCSM. If validated, future randomized noninferiority studies evaluating deescalated treatment approaches in men with ComboGS could be considered.
Harvard Radiation Oncology Program, Boston, MA. Electronic address: jphillips@lroc.harvard.edu.
John G
JG
Phillips
Harvard Radiation Oncology Program, Boston, MA.
Ayal A
AA
Aizer
Department of Statistics, University of Connecticut, Storrs, CT.
Ming-Hui
MH
Chen
Department of Statistics, University of Connecticut, Storrs, CT.
Danjie
D
Zhang
Department of Pathology, Brigham and Women's Hospital, Boston, MA.
Michelle S
MS
Hirsch
Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Jerome P
JP
Richie
Division of MRI, Department of Radiology, Brigham and Women's Hospital, Boston, MA.
Clare M
CM
Tempany
Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Stephen
S
Williams
Harvard Medical School, Boston, MA.
John V
JV
Hegde
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.
Marian J
MJ
Loffredo
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.
Anthony V
AV
D'Amico
D001706:Biopsy; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen
ComboGS; Pathology; Prognostic factors; Prostate cancer-specific mortality; Radical prostatectomy