Oncologic outcomes of organ-confined Gleason grade group 4-5 prostate cancer after radical prostatectomy

208 Background: Treatment of high risk prostate cancer (HRPCa) with external beam radiotherapy (EBRT) plus brachytherapy (BT) boost (EBRT+BT) has been prospectively associated with lower rates of BCR, albeit potentially with increased toxicity, and retrospectively linked to decreased distant metastasis (DM) and PCa-specific mortality (PCSM) compared to EBRT alone. However, it is unclear whether patients who develop BCR following either approach have similar downstream oncologic outcomes. Methods: We identified 706 out of 3820 men with HRPCa treated at 13 institutions from 1998-2015 with EBRT (n=468/2134) or EBRT+BT (n=238/1686) who developed BCR. We compared rates of DM, PCSM, and all-cause mortality (ACM) after BCR between treatment groups using Fine-Gray competing risk regression. Models were adjusted for age, Gleason grade group, initial PSA (iPSA), clinical T stage, time-dependent use of systemic salvage, and interval to BCR using inverse probability of treatment weighting. Results: Median follow-up was 9.9 years from RT and 4.8 years from BCR. Groups were similar in age, iPSA, presence of ≥2 HR features, and median interval to BCR (3.3 years). Most men received neoadjuvant/concurrent androgen deprivation therapy (ADT), 92.5% and 91.0% for EBRT and EBRT+BT, respectively, though for a longer duration with EBRT (median 14.7 vs. 9.0 months, p=0.0012). Local and systemic salvage rates were 2.3% and 36.3% after EBRT, and 2.6% and 43.6% after EBRT+BT, respectively. Initial EBRT+BT was associated with significantly lower rates of DM after BCR (HR 0.48, 95% CI 0.36-0.64, p<0.001). Rates of PCSM and ACM did not significantly differ (HR 0.93, 95% CI 0.67-1.30, p=0.93, and HR 0.8, 95% CI 0.6-1.1, p=0.11, respectively). Conclusions: In this large retrospective series of radiorecurrent HRPCa, initial treatment with EBRT+BT was associated with significantly lower rates of DM after BCR compared with EBRT, despite shorter ADT use and a similar median interval to BCR. Local salvage was widely underutilized in both groups. In the absence of salvage for local failure after EBRT, upfront treatment intensification with BT may reduce DM, though not PCSM or ACM, even after development of BCR.

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Questioning the Status Quo: Should Gleason Grade Group 1 Prostate Cancer be Considered a “Negative Core” in Pre-Radical Prostatectomy Risk Nomograms? An International Multicenter Analysis

Urology ◽

10.1016/j.urology.2019.10.012 ◽

2020 ◽

Vol 137 ◽

pp. 102-107

Author(s):

Joon Yau Leong ◽

Jaime O. Herrera-Caceres ◽

Hanan Goldberg ◽

Elwin Tham ◽

Seth Teplitsky ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Status Quo ◽

Gleason Grade ◽

Grade Group ◽

The Status ◽

Multicenter Analysis ◽

International Multicenter ◽

Group 1

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The impact of tertiary Gleason pattern 5 in the grade group system on recurrence following radical prostatectomy in patients with prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.44 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 44-44

Author(s):

Masashi Kato ◽

Toyonori Tsuzuki ◽

Ryo Ishida ◽

Tohru Kimura ◽

Osamu Kamihira ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Grade Group ◽

Group System ◽

Gleason Pattern ◽

Group 4 ◽

Significant Difference ◽

Psa Progression ◽

Group 3 ◽

Group 2

44 Background: The current ISUP/WHO grade group system classified the Gleason grade into five groups. Although presence of tertiary Gleason pattern 5 (tG5) reported to be related with unfavorable tumor characteristic, only a few data is available about influences on the grade group system of tG5 so far. In this study, we evaluated the effect of tG5 on recurrence following radical prostatectomy in patients with prostate cancer. Methods: We retrospectively evaluated 1,020 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. After excluding the patients with missing data or slides, 1000 patients were enrolled in this study. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014. Recurrence following radical prostatectomy was defined according to European Association of Urology guidelines. The endpoint was defined as an increase in PSA level. Results: Patient median age was 67 years (range 49–77 years). The median serum PSA was 6.9 ng/mL (range 0.4–82 ng/mL). The median follow-up period was 69 months (range 0.7–134 months). All the patients showed Group1:163 cases (16.3%), Group2: 436 (43.6%), Group 2 with tG5: 54 (5.4%), Group 3:121 (12.1%), Group 3 with tG5: 89 (8.9%), Group 4: 39 (3.9%), and Group 5: 98 (9.8%). PSA progression-free survival was significantly different among the five groups (Group1-5) (p = 0.0001). As concerning tG5, it showed significant difference between Group 2 and Group 2 with tG5 by using log rank test (p < 0.0001). Similarly, there was significant difference between Group 3 and Group 3 with tG5 (p = 0.001). On the other hand, there was no difference between Group 2 with tG5 and Group 3 (p = 0.916), and in the same way, no difference between Group 3 with tG5 and Group 4 (p = 0.854). Conclusions: The Presence of tG5 on the grade group system increase PSA progression following radical prostatectomy in patients with prostate cancer. Especially, Group 2 and 3 showed upgrade by presence of tG5. Integrating tG5 into the grade group system will improve the accuracy of patient outcome predictions.

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A nationwide trend away from radical prostatectomy for Gleason grade group 1 prostate cancer

BJU International ◽

10.1111/bju.15656 ◽

2021 ◽

Author(s):

Joseph B John ◽

John Pascoe ◽

Sarah Fowler ◽

Thomas Walton ◽

Mark Johnson ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Grade ◽

Grade Group ◽

Group 1

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Computationally Derived Cribriform Area Index from Prostate Cancer Hematoxylin and Eosin Images Is Associated with Biochemical Recurrence Following Radical Prostatectomy and Is Most Prognostic in Gleason Grade Group 2

European Urology Focus ◽

10.1016/j.euf.2021.04.016 ◽

2021 ◽

Author(s):

Patrick Leo ◽

Sacheth Chandramouli ◽

Xavier Farré ◽

Robin Elliott ◽

Andrew Janowczyk ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Gleason Grade ◽

Grade Group ◽

Area Index ◽

Hematoxylin And Eosin ◽

Group 2

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The role of mpMRI in qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy

BMC Urology ◽

10.1186/s12894-021-00850-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Łukasz Nyk ◽

Omar Tayara ◽

Tomasz Ząbkowski ◽

Piotr Kryst ◽

Aneta Andrychowicz ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Digital Rectal Examination ◽

Gleason Grade ◽

Shared Decision ◽

Grade Group ◽

Final Pathology ◽

Radical Treatment ◽

Pathological Report

Abstract Background To investigate the role of mpMRI and high PIRADS score as independent triggers in the qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy. Methods Between January 2017 and June 2019, 494 laparoscopic radical prostatectomies were performed in our institution, including 203 patients (41.1%) with ISUP 1 cT1c-2c PCa on biopsy. Data regarding biopsy results, digital rectal examination, PSA, mpMRI and postoperative pathological report have been retrospectively analysed. Results In 183 cases (90.1%) mpMRI has been performed at least 6 weeks after biopsy. Final pathology revealed ISUP Gleason Grade Group upgrade in 62.6% of cases. PIRADS 5, PIRADS 4 and PIRADS 3 were associated with Gleason Grade Group upgrade in 70.5%, 62.8%, 48.3% of patients on final pathology, respectively. Within PIRADS 5 group, the number of upgraded cases was statistically significant. Conclusions PIRADS score correlates with an upgrade on final pathology and may justify shared decision of radical treatment in patients unwilling to repeated biopsies. However, the use of PIRADS 5 score as a sole indicator for prostatectomy may result in nonnegligible overtreatment rate.

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Predicting Prostate Cancer Upgrading of Biopsy Gleason Grade Group at Radical Prostatectomy Using Machine Learning-assisted Decision-support Models

10.21203/rs.3.rs-78116/v1 ◽

2020 ◽

Author(s):

Hailang Liu ◽

Kun Tang ◽

Ejun Peng ◽

Liang Wang ◽

Ding Xia ◽

...

Keyword(s):

Prostate Cancer ◽

Machine Learning ◽

Logistic Regression ◽

Radical Prostatectomy ◽

Predictive Value ◽

Support Vector ◽

Gleason Grade ◽

Good Discrimination ◽

Grade Group ◽

Testing Dataset

Abstract Background: This study aimed to develop a machine learning (ML)-assisted model capable of accurately predicting the probability of biopsy Gleason grade group upgrading before making treatment decisions.Methods: We retrospectively collected data from prostate cancer (PCa) patients who underwent systematic biopsy and radical prostatectomy from January 2015 to December 2019 at Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology. The study cohort was divided into training and testing datasets in a 70:30 ratio for further analysis. Four ML-assisted models were developed from 16 clinical features using logistic regression (LR), logistic regression optimized by least absolute shrinkage and selection operator (Lasso) regularization (Lasso-LR), random forest (RF) and support vector machine (SVM). The area under the curve (AUC) was applied to determine the model with the highest discrimination. Calibration plots were used to investigate the extent of over- or underestimation of predicted probabilities relative to the observed probabilities in models. Results: In total, 530 PCa patients were included, with 371 patients in the training dataset and 159 patients in the testing dataset. The Lasso-LR model showed good discrimination with an AUC, accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 0.776, 0.712, 0.679, 0.745, 0.730 and 0.695, respectively, followed by SVM (AUC 0.740, 95% confidence interval [CI]: 0.690–0.790), LR (AUC 0.725, 95% CI: 0.674–0.776) and RF (AUC 0.666, 95% CI: 0.618–0.714). Validation of the model showed that the Lasso-LR model had the best discriminative power (AUC 0.735, 95% CI: 0.656–0.813), followed by SVM (AUC 0.723, 95% CI: 0.644–0.802), LR (AUC 0.697, 95% CI: 0.615–0.778) and RF (AUC 0.607, 95% CI: 0.531–0.684) in the testing dataset. Both the Lasso-LR and SVM models were well-calibrated. Conclusion: The Lasso-LR model had good discrimination in the prediction of patients at high risk of harboring incorrect Gleason grade group assignment, and the use of this model may be greatly beneficial to urologists in treatment planning, patient selection, and the decision-making process for PCa patients.

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The Clinical Impact of Unilateral Versus Bilateral Invasion Into the Seminal Vesicle in Patients With Prostate Cancer Undergoing Radical Prostatectomy

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2021-0265-oa ◽

2021 ◽

Author(s):

Numbereye Numbere ◽

Yuki Teramoto ◽

Pratik M. S. Gurung ◽

Ying Wang ◽

Zhiming Yang ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Seminal Vesicle ◽

Surgical Margin ◽

Tumor Grade ◽

Oncologic Outcomes ◽

Outcome Analysis ◽

Positive Surgical Margin ◽

Grade Group ◽

Histopathologic Features

Context.— Seminal vesicle involvement by prostate cancer has generally been considered as a key prognosticator. Objective.— To assess the clinical significance of unilateral (Uni) versus bilateral (Bil) seminal vesicle invasion (SVI). Design.— We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients showing Uni-SVI (n = 139) versus Bil-SVI (n = 109). Results.— Tumor grade was significantly higher in Bil-SVI cases than in Uni-SVI cases. Additionally, Bil-SVI was significantly associated with a higher incidence of lymphovascular invasion, lymph node metastasis, or positive surgical margin, and larger estimated tumor volume. When the histopathologic features at SVI foci were compared, Grade Group (GG) 3-5/4-5/5 and cribriform morphology were significantly more often seen in Bil-SVI. Outcome analysis revealed that patients with Bil-SVI had a significantly higher risk of disease progression (P < .001) than patients with Uni-SVI. Significantly worse progression-free survival in patients with Bil-SVI was also observed in all subgroups examined, including those with no immediate adjuvant therapy (IAT) (n = 139; P = .01), IAT (n = 109; P = .001), pN0 disease (n = 153; P = .002), or pN1 disease (n = 93; P = .006). In multivariate analysis, Bil-SVI (versus Uni-SVI) showed significance for progression in the entire (hazard ratio [HR] = 1.83, P = .01), IAT (HR = 2.90, P = .006), and pN0 (HR = 2.05, P = .01) cohorts. Meanwhile, tumor grade at SVI (eg, GG4, GG5), as an independent predictor, was significantly associated with patient outcomes. Conclusions.— Bil-SVI was found to be strongly associated with worse histopathologic features on radical prostatectomy and poorer prognosis. Pathologists may thus need to report Uni-SVI versus Bil-SVI, along with other histopathologic findings, such as Gleason score, at SVI in prostatectomy specimens.

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