Clinical usefulness of total length of Gleason pattern 4 on biopsy in men with Grade Group 2 prostate cancer Journal Article


Authors: Dean, L. W.; Assel, M.; Sjoberg, D. D.; Vickers, A. J.; Al-Ahmadie, H. A.; Chen, Y. B.; Gopalan, A.; Sirintrapun, S. J.; Tickoo, S. K.; Eastham, J. A.; Scardino, P. T.; Reuter, V. E.; Ehdaie, B.; Fine, S. W.
Article Title: Clinical usefulness of total length of Gleason pattern 4 on biopsy in men with Grade Group 2 prostate cancer
Abstract: PURPOSE: To our knowledge the ideal methodology of quantifying secondary Gleason pattern 4 in men with Grade Group 2/Gleason score 3 + 4 = 7 on biopsy remains unknown. We compared various methods of Gleason pattern 4 quantification and evaluated associations with adverse pathology findings at radical prostatectomy. MATERIALS AND METHODS: A total of 457 men with Grade Group 2 prostate cancer on biopsy subsequently underwent radical prostatectomy at our institution. Only patients with 12 or more reviewed cores were included in analysis. We evaluated 3 methods of quantifying Gleason pattern 4, including the maximum percent of Gleason pattern 4 in any single core, the overall percent of Gleason pattern 4 (Gleason pattern 4 mm/total cancer mm) and the total length of Gleason pattern 4 in mm across all cores. Adverse pathology features at radical prostatectomy were defined as Gleason score 4 + 3 = 7 or greater (Grade Group 3 or greater), and any extraprostatic extension, seminal vesical invasion and/or lymph node metastasis. A training/test set approach and multivariable logistic regression were used to determine whether Gleason pattern 4 quantification methods could aid in predicting adverse pathology. RESULTS: On multivariable analysis all Gleason pattern 4 quantification methods were significantly associated with an increased risk of adverse pathology (p <0.0001) and an increased AUC beyond the base model. The largest AUC increase was 0.044 for the total length of Gleason pattern 4 (AUC 0.728, 95% CI 0.663-0.793). Decision curve analysis demonstrated an increased clinical net benefit with the addition of Gleason pattern 4 quantification to the base model. The total length of Gleason pattern 4 clearly provided the largest net benefit. CONCLUSIONS: Our findings support the inclusion of Gleason pattern 4 quantification in the pathology reports and risk prediction models of patients with Grade Group 2/Gleason score 3 + 4 = 7 prostate cancer. The total length of Gleason pattern 4 across all cores provided the strongest benefit to predict adverse pathology features.
Journal Title: Journal of Urology
Volume: 201
Issue: 1
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2019-01-01
Start Page: 77
End Page: 82
Language: English
DOI: 10.1016/j.juro.2018.07.062
PUBMED: 30076908
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 1 February 2019 -- Source: Scopus
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MSK Authors
  1. Peter T Scardino
    615 Scardino
  2. Satish K Tickoo
    367 Tickoo
  3. Anuradha Gopalan
    271 Gopalan
  4. Yingbei Chen
    220 Chen
  5. Andrew J Vickers
    544 Vickers
  6. Daniel D. Sjoberg
    134 Sjoberg
  7. Behfar Ehdaie
    72 Ehdaie
  8. James Eastham
    422 Eastham
  9. Samson W Fine
    313 Fine
  10. Victor Reuter
    890 Reuter
  11. Melissa Jean Assel
    34 Assel
  12. Lucas Wyatt Dean
    2 Dean