e544 Background: Presently, the highest Gleason Grade Group (GGG) is the metric used to gauge the clinical aggressiveness of tumor and dictate treatment. However, the urologist is limited by lack of consideration of the entire biopsy using that single parameter alone. Intuitively we presumed that the biopsy showing multiple cores of cancer would represent more aggressive disease. Herein, we propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes histopathologic data and cancer volume into a single numeric value representing the entire biopsy that provides the urologist with the ability to more accurately predict adverse pathologic outcomes of prostatectomy. Methods: We studied 212 men who underwent radical prostatectomy after standard multi-core prostate biopsy. The highest Gleason score of each biopsy was converted to its final GGG. The WGGG was calculated by summing the Gleason score of each positive core and normalized for a 12 core total. Radical prostatectomy pathology was studied to determine adverse pathological outcomes, specifically, extraprostatic extension (EPE), positive surgical margins (PSM), lymphovascular invasion (LVI), seminal vesical invasion (SVI) and pathological upgrading. Logistic regression analysis was used to compare the ability of conventional GGG versus WGGG to predict the risk of these adverse features. Results: The odds ratio (OR) for predicting EPE, SVI and LVI for increasing GGG versus WGGG (in 10-point incremental increases) were 1.16 (95% CI 1.1-1.2, p < 0.001) versus 1.81 (95% CI 1.42-2.32, p < 0.001), versus 2.05 (95% CI 1.45-2.90, p < 0.001) and versus 3.46 (95% CI 1.99-6.04, p < 0.001), respectively. WGGG, but not GGG was significantly associated with PSM 1.07 (95% CI 1.029-1.104, p = 0.004) and pathologic upgrading 1.621 (95% CI 1.461- 1.837, p = 0.002) of the prostatectomy specimen. Conclusions: The WGGG, by providing a measurable value reflecting the entirety of the prostate biopsy, is more informative than conventional single GGG alone in reliably predicting adverse pathologic outcomes on radical prostatectomy specimens.
MRI-Fusion Targeted vs. Systematic Prostate Biopsy–How Does the Biopsy Technique Affect Gleason Grade Concordance and Upgrading After Radical Prostatectomy?
