title: Prostate cancer outcomes of men with biopsy Gleason score 6 and 7 without cribriform or intraductal carcinoma.
abstract: Gleason score (GS) 3 + 4 = 7 prostate cancer patients with presence of cribriform or intraductal carcinoma (7(+)) have a worse disease-specific survival than those without. The aim of this study was to compare the clinicopathologic characteristics and patient outcomes of men with biopsy GS 3 + 4 = 7 without cribriform or intraductal carcinoma (7(-)) to those with GS 3 + 3 = 6.
  
  
  
  We included all patients from the first screening round of the European Randomized Study of Screening for Prostate Cancer (1993-2000) with a revised GS ≤ 3 + 4 = 7 (n = 796) following the 2014 International Society of Urological Pathology criteria. Relations with biochemical recurrence after radical prostatectomy or radiotherapy were analysed using log-rank testing and multivariable Cox regression analysis.
  
  
  
  In total, 486 patients had GS 6 and 310 had GS 7, 54 of whom had GS 7(+) (17%). During a median follow-up of 15 years, biochemical recurrence was seen in 61 (20%) GS 6, 54 (21%) GS 7(-) and 22 (41%) GS 7(+) patients (41%). Both biopsy GS 7(-) and 7(+) patients had significantly higher prostate-specific antigen levels, mean tumour percentage, percentage of positive cores and ≥cT3 than those with GS 6 (all P < .001). GS 7(-) patients did not have a poorer biochemical recurrence-free survival (BCRFS) after radical prostatectomy than GS 6 patients (log-rank P = .13), whereas those with GS 7(+) had (log-rank P = .05). In multivariable analyses, biopsy GS 7(-) was not associated with poorer BCRFS after radical prostatectomy (hazard ratio [HR], 1.3; 95% confidence interval [CI]: 0.67-2.4; P = .47) or radiotherapy (HR, 0.88; 95% CI: 0.51-1.5; P = .63). GS 7(+) was independently associated with poorer BCRFS after radical prostatectomy (HR, 3.0; 95% CI: 1.1-7.8; P = .03), but not after radiotherapy (HR, 1.2; 95% CI: 0.58-2.3; P = .67).
  
  
  
  Men with biopsy GS 7(-) prostate cancer have similar BCRFS after radical prostatectomy or radiotherapy to those with GS 6 and may be candidates for active surveillance as long as other inclusion criteria such as on PSA and tumour volume are met.
authors: Department of Pathology, Erasmus Medical Centre Rotterdam, The Netherlands. Electronic address: c.kweldam@erasmusmc.nl.
authors: Charlotte F
authors: CF
authors: Kweldam
authors: Department of Pathology, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Intan P
authors: IP
authors: Kümmerlin
authors: Department of Public Health, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Daan
authors: D
authors: Nieboer
authors: Department of Pathology, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Esther I
authors: EI
authors: Verhoef
authors: Department of Public Health, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Ewout W
authors: EW
authors: Steyerberg
authors: Department of Radiotherapy, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Luca
authors: L
authors: Incrocci
authors: Department of Urology, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Chris H
authors: CH
authors: Bangma
authors: Laboratory Medicine Program, University Health Network, Toronto, Canada.
authors: Theodorus H
authors: TH
authors: van der Kwast
authors: Department of Urology, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Monique J
authors: MJ
authors: Roobol
authors: Department of Pathology, Erasmus Medical Centre Rotterdam, The Netherlands.
authors: Geert J
authors: GJ
authors: van Leenders
mesh_terms: D017668:Age of Onset; D000368:Aged; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009426:Netherlands / Q000453:epidemiology; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy
chemical_list: D017430:Prostate-Specific Antigen
keywords: Cribriform; Intraductal carcinoma; Prostate cancer