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

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

Author information

1
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Urology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: michael.leapman@yale.edu.
2
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
3
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
4
Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
5
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.

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

PMID:
27940155
DOI:
10.1016/j.eururo.2016.11.032
[Indexed for MEDLINE]

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