Impact of Primary Gleason Grade on Risk Stratification for Gleason Score 7 Prostate Cancers

Background: Prostatic carcinoma is one of the most common carcinomas among men throughout the world. Gleason score (GS) system is used in reporting and assessing the prognosis of prostatic carcinoma. The GS has undergone modifications. The objective of this study is to evaluate the impact of the new 2014 ISUP Modified Gleason System and Gleason grading (GG) on reporting of prostatic carcinoma. Methodology: This is a retrospective Study. All cases reported as adenocarcinoma prostate from January 2013 to July 2018 were included in the study. The GS done previously as per 2005 criteria was noted. The GS system and GG were done on the microslides retrieved as per 2015 criteria and compared with that of GS already recorded and also with old risk stratification. Results: Comparing the GS of 2005 and 2015 criteria, there was a marked decrease (80%) in Gleason score 6; among these cases, 80% cases were graded as score 7, and 20% cases were graded as score 8. There is also a 28.57% decrease in Gleason score 8 and 60% increase in Gleason score 9 due to the new criteria for pattern 4. The GG 1,2,3,4 and 5 constituted 3.03%, 18.18%, 15.15%, 15.15%, and 48.49% of cases respectively. Conclusion: The new GS and GG has more impact on prognosis of adenocarcinoma prostate as GS 6 has better prognosis and GG gives better risk stratification compared to the previous risk stratification.

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Prostate image-guided transperineal elastic-registration biopsy, a new diagnostic tool to refine the risk-stratification of prostate cancer and improve therapeutic decisions.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16595 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16595-e16595

Author(s):

Pierre Graff-Cailleaud ◽

Bertrand Covin ◽

Daniel Portalez ◽

Richard Aziza ◽

Jonathan Khalifa ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Stratification ◽

Active Surveillance ◽

Gleason Score ◽

Risk Groups ◽

Gleason Grade ◽

Curative Intent ◽

Elastic Registration ◽

Image Guided ◽

Therapeutic Decisions

e16595 Background: To evaluate image-guided Transperineal Elastic-Registration biopsy (TPER-B) in the risk-stratification of low-to-intermediate risk prostate cancer detected by Transrectal-ultrasound biopsy (TRUS-B) when estimates of cancer grade and volume discorded with multiparametric Magnetic Resonance Imaging (MRI). Methods: All patients referred for active surveillance or organ-conservative management were collegially reviewed for consistency between TRUS-B results and MRI. Image-guided TPER-B of the index target (IT) defined as the largest Prostate Imaging-Reporting Data System-v2 ≥3 abnormality were organized for discordant cases. Pathology reported Gleason grade, maximum cancer core length (MCCL) and total CCL (TCCL). Results: Of 237 prostate cancer patients (1-7/2018), 42 required TPER-B for risk-stratification. Eight cores were obtained [Median&IQR: 8 (6-10)] including five (IQR: 4-6) in the IT. TPER-B of the IT yielded longer MCCL [Mean&(95%CI): 5.4(3.9-6.9) vs. 2.5mm(1.9-3.1), p = 0.002] and TCCL [16.7(10.6-22.8) vs. 3.9mm(3.1-4.8), p = 0.0001] than TRUS-B of the gland. On TPER-B cores, longer TCCL [Mean&(95%CI): 28.9mm(19.1-38.7) vs. 12.3mm(4.8-19.7), p = 0.02] were measured in Gleason score-7 than score-6 cancers (no cancers detected on IT TPER-B in 11 patients, all but one score 6 < 4mm on TRUS-B). TPER-B cores of the IT upgraded 16/42(38.1%) patients. 21/42(50.0%) met University College London-definition 1 (Gleason score≥4+3 and/or MCL≥6mm) and 27/42(64.3%) definition 2 (Gleason score≥3+4 and/or MCL≥4mm), which correlate to clinically significant cancers > 0.5mL and > 0.2mL, respectively. Allocation to higher risk groups than anticipated from TRUS-B spurred adaptation of treatment protocols (active surveillance n = 15, prostatectomy n = 11, ionizing radiation n = 13, pending n = 3). Conclusions: Image-guided TPER-B of the index target provided more cancer material for pathology. Subsequent re-evaluation of cancer volume and grade switched a majority of patients towards higher risk groups and treatments with curative intent.

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SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate Risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines

Frontiers in Oncology ◽

10.3389/fonc.2014.00312 ◽

2014 ◽

Vol 4 ◽

Cited By ~ 7

Author(s):

Matthew Bernetich ◽

Caspian Oliai ◽

Rachelle Lanciano ◽

Alexandra Hanlon ◽

John Lamond ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Stratification ◽

Gleason Score ◽

Primary Treatment ◽

Localized Prostate Cancer ◽

Intermediate Risk

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Expression of Cysteine Protease Protein 32 in Prostatic Adenocarcinoma Correlates With Tumor Grade

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-649-eocppi ◽

2004 ◽

Vol 128 (6) ◽

pp. 649-652

Author(s):

Shahgul Anwar ◽

Robert A. Ambros ◽

Timothy A. Jennings ◽

Jeffrey S. Ross ◽

Anton Beza ◽

...

Keyword(s):

Gleason Score ◽

Cysteine Protease ◽

Tumor Grade ◽

Cysteine Proteases ◽

Prostatic Adenocarcinoma ◽

Gleason Grade ◽

High Grade ◽

Cytoplasmic Staining ◽

Apoptosis Pathway ◽

High Gleason Score

Abstract Context.—Controlled cell death is mediated by apoptosis-specific genes, tumor suppressor genes, and oncogenes. The caspase family is a group of at least 15 known cysteine proteases that serve as initiator and effector molecules of the apoptosis pathway. On activation, caspases cause cell shrinkage, condensation of chromatin, fragmentation of DNA, and the formation of blebs in the cytoplasmic membrane. Objectives.—The patterns of cysteine protease protein (CCP) 32 (caspase-3) expression have been determined in normal human tissues and a variety of tumors, and have been shown to correlate with the outcome in breast cancer and linked to resistance to chemotherapy in other tumors. This study was performed to determine whether CPP32 is expressed in prostatic adenocarcinoma and to define its relationship with outcome variables. Design.—Formalin-fixed, paraffin-embedded radical prostatectomy specimens from 211 patients with prostatic adenocarcinoma were evaluated for CPP32 expression by immunohistochemistry. Hematoxylin-eosin–stained slides were reviewed, and tumors were graded based on the Gleason grading system. Tumors were scored for CPP32 expression semiquantitatively, based on the staining intensity and distribution patterns. These results were compared with Gleason grade and clinical and pathologic stages. Results.—One hundred thirty-three (63%) of 211 cases showed high expression of CPP32, whereas expression was low in 78 (37%) cases. One hundred three (49%) of 211 cases had a high Gleason score (7 and above). Of 103 cases with a high Gleason score, 74 (72%) showed high CPP32 expression. Strong cytoplasmic staining for CPP32 in high-grade tumors was statistically significant (P = .01). Also, by linear regression analysis a significant correlation was seen between the Gleason score and the cytoplasmic CPP32 expression (P = .001). Expression of CPP32 did not correlate with either clinical stage (P = .28) or pathologic stage (P = .60); however, this study included very few patients with stage IV disease. Conclusion.—The correlation between CPP32 and high tumor grade suggests a CPP32-related high turnover rate in high-grade prostatic adenocarcinoma. Moreover, strong correlation with Gleason grade, a powerful predictor of disease progression and overall survival, suggests potential usefulness of CPP32 as a prognostic factor, especially in limited biopsy samples.

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Limited Sampling of Radical Prostatectomy Specimens With Excellent Preservation of Prognostic Parameters of Prostate Cancer

Archives of Pathology & Laboratory Medicine ◽

10.5858/133.8.1278 ◽

2009 ◽

Vol 133 (8) ◽

pp. 1278-1284

Author(s):

Kyungeun Kim ◽

Pil June Pak ◽

Jae Y. Ro ◽

Dongik Shin ◽

Soo-Jin Huh ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Sampling Method ◽

Resection Margin ◽

Gleason Grade ◽

Posterior Half ◽

Margin Involvement ◽

Partial Sampling ◽

Prostate Cancers ◽

Extraprostatic Extension

Abstract Context.—The widespread use of the serum prostate-specific antigen test has increased the early detection of prostate cancer and consequently reduced grossly definable prostate cancers. Objective.—To find the most efficient gross sampling method for radical prostatectomy specimens not only preserving important prognostic factors but also being cost effective. Design.—We initially analyzed clinicopathologic features of the entire prostate sections from 148 radical prostatectomy specimens, which then were used to examine the impact of 5 partial sampling methods on tumor stage, Gleason score, extraprostatic extension, resection margin status, and paraffin block numbers. The methods included submission of (1) alternative slices, (2) alternative slices plus biopsy-positive posterior quarters, (3) every posterior half, (4) every posterior half plus one midanterior half, and (5) alternative slices plus peripheral 3-mm rim of the remaining prostate. Results.—Prostate cancers and their extraprostatic extension and resection margin involvement were commonly located in the right posterior portion of the prostate. Method 5 was most efficient, detecting all cases with extraprostatic extension and resection margin involvement and reducing 25% of paraffin blocks compared with the entire sampling of the prostate. The Gleason scores were retained in most of cases, except reversal of the primary and secondary Gleason grade component in only 2 cases (1%). Only 4 cases (3%) were downstaged within the same T2 stage. Conclusions.—These results demonstrate that sampling of alternative slices plus peripheral rim of the remaining prostate is the most efficient partial sampling method for radical prostatectomy specimens.

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Pre-treatment risk stratification of prostate cancer patients:A critical review

Canadian Urological Association Journal ◽

10.5489/cuaj.148 ◽

2012 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

George Rodrigues ◽

Padraig Warde ◽

Tom Pickles ◽

Juanita Crook ◽

Michael Brundage ◽

...

Keyword(s):

Prostate Cancer ◽

Prognostic Factors ◽

Cancer Risk ◽

Risk Stratification ◽

Gleason Score ◽

Critical Review ◽

Specific Antigen ◽

Prostate Cancer Risk ◽

Original Research ◽

Pre Treatment

Introduction: The use of accepted prostate cancer risk stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated risk stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer risk stratification schema to assess the feasibility and need for changes to existing risk stratification systems. Methods: A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and risk stratification in prostate cancer. Search terms included risk stratification, risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing risk stratification schema. Results: The critical review identified three specific clinically relevant potential changes to the most commonly used three-group risk stratification system: (1) the creation of a very-low risk category; (2) the splitting of intermediate-risk into a low- and highintermediate risk groups; and (3) the clarification of the interface between intermediate- and high-risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important risk-stratification factors. Conclusions: Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer risk stratification systems. We propose potential changes to existing systems.

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PREDICTION OF GLEASON SCORE UPGRADING IN LOW RISK PROSTATE CANCERS DIAGNOSED VIA MULTI (≥ 12)-CORE PROSTATE BIOPSY

The Journal of Urology ◽

10.1016/s0022-5347(09)61993-5 ◽

2009 ◽

Vol 181 (4) ◽

pp. 713

Author(s):

Sung Kyu Hong ◽

Seung Tae Lee ◽

Byung Kyu Han ◽

Myung Kim ◽

Sung-Soo Kim ◽

...

Keyword(s):

Gleason Score ◽

Prostate Biopsy ◽

Low Risk ◽

Prostate Cancers

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218MO Comparison of a 22-gene genomic classifier (GC) with NCCN for risk stratification of Asian prostate cancers (PCa)

Annals of Oncology ◽

10.1016/j.annonc.2020.10.438 ◽

2020 ◽

Vol 31 ◽

pp. S1325-S1326

Author(s):

W. Wai Yee ◽

A.Y.L. Sim ◽

K.P. Low ◽

A. Meng ◽

J. Tan ◽

...

Keyword(s):

Risk Stratification ◽

Prostate Cancers

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Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort

European Radiology ◽

10.1007/s00330-020-07256-z ◽

2020 ◽

Cited By ~ 2

Author(s):

Francesco Giganti ◽

Armando Stabile ◽

Vasilis Stavrinides ◽

Elizabeth Osinibi ◽

Adam Retter ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Gleason Score ◽

Rank Test ◽

Gleason Grade ◽

Clinical Progression ◽

Radiological Progression ◽

Grade Group ◽

Psa Density

Abstract Objectives The PRECISE recommendations for magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer (PCa) include repeated measurement of each lesion, and attribution of a PRECISE radiological progression score for the likelihood of clinically significant change over time. We aimed to compare the PRECISE score with clinical progression in patients who are managed using an MRI-led AS protocol. Methods A total of 553 patients on AS for low- and intermediate-risk PCa (up to Gleason score 3 + 4) who had two or more MRI scans performed between December 2005 and January 2020 were included. Overall, 2161 scans were retrospectively re-reported by a dedicated radiologist to give a PI-RADS v2 score for each scan and assess the PRECISE score for each follow-up scan. Clinical progression was defined by histological progression to ≥ Gleason score 4 + 3 (Gleason Grade Group 3) and/or initiation of active treatment. Progression-free survival was assessed using Kaplan-Meier curves and log-rank test was used to assess differences between curves. Results Overall, 165/553 (30%) patients experienced the primary outcome of clinical progression (median follow-up, 74.5 months; interquartile ranges, 53–98). Of all patients, 313/553 (57%) did not show radiological progression on MRI (PRECISE 1–3), of which 296/313 (95%) had also no clinical progression. Of the remaining 240/553 patients (43%) with radiological progression on MRI (PRECISE 4–5), 146/240 (61%) experienced clinical progression (p < 0.0001). Patients with radiological progression on MRI (PRECISE 4-5) showed a trend to an increase in PSA density. Conclusions Patients without radiological progression on MRI (PRECISE 1-3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy. Key Points • Patients without radiological progression on MRI (PRECISE 1–3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy. • Clinical progression was almost always detectable in patients with radiological progression on MRI (PRECISE 4–5) during AS. • Patients with radiological progression on MRI (PRECISE 4–5) during AS showed a trend to an increase in PSA density.

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