Platinum Priority – Prostate CancerApplication of a Prognostic Gleason Grade Grouping System to Assess Distant Prostate Cancer Outcomes
Introduction
Conceived five decades ago, the Gleason scoring system is a clinical variable strongly associated with prostate cancer (PCa) outcome [1]. With time, incremental modifications to the standards for pathologic reporting have allowed for greater agreement between biopsy and radical prostatectomy (RP) specimens, yet have resulted in the elimination of nearly half of the initially proposed Gleason scores (ie, sums 2–5) [2], [3], [4]. A well-recognized communication challenge has emerged whereby the lowest assigned Gleason sum associated with PCa is reported as 6 on a scale from 2 to 10. As a result, a reduction in the practical histologic spectrum may serve to misrepresent the degree of clinical risk and potentially compound the problem of overtreatment for men with low-grade tumors with a perceived higher than actual risk.
A novel grade grouping system offering five tiers consistent with modern reporting conventions has been proposed, and there has been a groundswell of momentum in support of its widespread adoption, including a recent announcement requiring consistent use for publication in major urologic oncology journals, including European Urology [5], [6]. To date, a number of validation studies examining the ability of this revised Gleason grading reporting system to predict clinical recurrence following definitive therapy have been published, as well as two publications addressing PCa-specific mortality following conservative management and radiotherapy [7], [8], [9], [10], [11], [12]. However, it is unknown if a reporting rubric that collapses the highest Gleason sums (group V) will in turn mask differences in clinical outcome within these subcategories, or whether such a system will perform adequately when broadly implemented outside of academic centers and across treatment types. Therefore, we aimed to evaluate the association of prognostic Gleason grade group with risk of PCa-specific mortality (PCSM) and the development of bone metastasis across management strategies among men in a large multicenter registry.
Section snippets
Patients and methods
Study participants were enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry initiated in 1995, which prospectively tracks clinical characteristics, treatment, relapse, survival, and quality-of-life outcomes for men with PCa [13]. CaPSURE comprises 43 sites, including 36 community-based practices, three academic centers, and four US Veterans Affairs medical centers. The study is managed under institutional review board supervision, with all patients
Results
The primary cohort consisted of 10 529 men whose primary management consisted of RP, EBRT, BT, ADT, or AS/WW. These included 6776 men (64%) in grade group I; 1773 (17%) in group II; 955 (9%) in group III; 636 (6%) in group IV; and 389 (4%) in group V. Men treated with RP were younger (mean age 61.6 yr) than those who underwent BT monotherapy (mean 68.0 yr), EBRT (mean 70.1 yr), primary ADT (73.0), or AS/WW (mean 71.4; p < 0.01. Median follow-up after treatment for patients not experiencing PCSM
Discussion
Comprehensible reporting of PCa histologic grades is likely to have an impact on a disease characterized by diversity in biology, clinical outcomes, management choices, and quality of information [15], [16], [17]. This may be particularly meaningful at the lower end of the spectrum, where high rates of treatment occur among those with Gleason score < 3 + 4 disease [18]. The prospect of removing historical vestiges within the Gleason scale (ie, sums 2–5) has long been advanced as one response to
Conclusions
We confirm that the new Gleason grouping system is associated with distant clinical endpoints across management strategies, including active surveillance, watchful-waiting and non-definitive therapy. No significant distinction in outcome was detected within the Gleason scores combined within the highest Grade grouping, however this represented a small proportion of men within the study cohort.
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2020, Pathology Research and PracticeCitation Excerpt :Noguchi et al. also found that the number of bone lesions seen on bone scans was significantly associated with CSS of PCa patients [15]. Additionally, the prognostic grade grouping system was associated with risk of metastasis [16]. The aim of this study is to evaluate the prognostic significance of IDC-P and bone metastasis in needle biopsy for Chinese PCa patients with Grade Group 5 disease using OS and CSS as an end point.