Application of a Prognostic Gleason Grade Grouping System to Assess Distant Prostate Cancer Outcomes

Eur Urol. 2017 May;71(5):750-759. doi: 10.1016/j.eururo.2016.11.032. Epub 2016 Dec 9.

Abstract

Background: There is growing enthusiasm for the adoption of a novel grade grouping system to better represent Gleason scores.

Objective: To evaluate the ability of prognostic Gleason grade groups to predict prostate cancer (PCa)-specific mortality (PCSM) and bone metastatic progression.

Design, setting, and participants: We identified patients with PCa enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry across treatment strategies, including conservative and nondefinitive therapy.

Outcome measurements and statistical analysis: We examined the prognostic ability of Gleason grade groups to predict risk of PCSM and bone metastasis using the Kaplan-Meier method and unadjusted and adjusted Cox proportional hazards models.

Results and limitations: We identified 10529 men with PCa followed for a median of 81 mo (interquartile range 40-127), including 64% in group I (< 3 + 4); 17% in group II (3+4); 9% in group III (4+3); 6% in group IV (4+4); and 4% in group V (≥ 4 + 5). Relative to grade group I, the unadjusted risks of PCSM and bone metastasis were significantly associated with prognostic grade groupings for both biopsy and prostatectomy samples (all p<0.01). Pairwise comparisons within Gleason sums collapsed within grade group V were not significant; however, this analysis was limited by a small representation of men with Gleason pattern ≥ 4 + 5.

Conclusions: The prognostic grade grouping system is associated with risk of PCSM and metastasis across management strategies, including definitive therapy, conservative management, and primary androgen deprivation.

Patient summary: A five-level reporting system for prostate cancer pathology is associated with the risk of late prostate cancer endpoints.

Keywords: Prognostic Gleason score; Prostate cancer; Prostate cancer–specific mortality.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / secondary*
  • Carcinoma / mortality*
  • Carcinoma / secondary
  • Disease Progression
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Grading
  • Prognosis
  • Proportional Hazards Models
  • Prostatic Neoplasms / mortality*
  • Prostatic Neoplasms / pathology