Introduction: Presently, prostate biopsy (PBx) results report the highest Gleason Grade Group (GGG) as a single metric that gauges the overall clinical aggressiveness of cancer and dictates treatment. We hypothesized a PBx showing multiple cores of cancer with more volume cancer per core would represent more aggressive disease. We propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes all histopathologic data and cancer volume into a single numeric value representing the entire PBx, allowing for improved prediction of adverse pathology and risk of biochemical recurrence (BCR) following radical prostatectomy (RP).
Methods: We studied 171 men who underwent RP after standard PBx. The WGGG was calculated by summing each positive core using the formula: GGG + (GGG x %Ca/core). RP pathology was evaluated for extraprostatic extension (EPE), positive surgical margins (PSM), seminal vesicle invasion (SVI), and lymph node involvement (LNI), and patients were followed for BCR. We compared GGG vs. WGGG receiver operating characteristic curves for each outcome, and determined the predictive capability of GGG and WGGG to identify patients with BCR. Categorized WGGG groups were created based on risk of BCR using classification and regression tree analysis. We then sought to externally validate WGGG in a cohort of 389 patients in a separate institutional dataset.
Results: In the development cohort, area under the curves (AUCs) for the WGGG vs. GGG were significantly higher for predicting EPE (0.784 vs. 0.690, P = 0.002), SVI (AUC 0.823 vs. 0.721, P = .014), LNI (AUC 0.862 vs. 0.823, P = 0.039), and PSM (AUC 0.638 vs. 0.575, P = 0.031. Analysis of the validation cohort showed similar findings for EPE (AUC 0.764 vs. 0.729, P = 0.13), SVI (AUC 0.819 vs. 0.749, P = 0.01), LNI (AUC 0.939 vs. 0.867, P = 0.02), and PSM (AUC 0.624 vs. 0.547, P = 0.04). Patients with WGGG >30 (high-risk group) demonstrated ∼50% failure at 2 years in both cohorts.
Conclusions: The WGGG, by providing a metric reflecting the entirety of the PBx, is more informative than conventional single GGG alone in identifying adverse pathologic outcomes and risk of BCR following RP. This superior discriminatory capability has been achieved without any consideration of other commonly available clinical disease characteristics.
Keywords: Biochemical recurrence; Biopsy; GGG; Gleason; Grade; Prostate; Prostate cancer.
Copyright © 2019 Elsevier Inc. All rights reserved.
Prediction of Biochemical Recurrence in Prostate Cancer Patients Who Underwent Prostatectomy Using Routine Clinical Prostate Multiparametric MRI and Decipher Genomic ScoreI Jambor et al. J Magn Reson Imaging. PMID 31566845.Forty-eight (53%) patients developed BCR. The best-performing individual features with TLPOCV AUC of 0.73 (95% confidence interval [CI] 0.64-0.82) were RALP GGG, MRI-lesi …
Management of Prostate Cancer Patients With Locally Adverse Pathologic Features After Radical Prostatectomy: Feasibility of Active Surveillance for Cases With Gleason Grade 3 + 4 = 7X Shangguan et al. J Cancer Res Clin Oncol 143 (1), 123-129. PMID 27650933.For the appropriate patient, depending on age, physical condition, early postoperative PSA, patient desire, etc., could be a candidate for wait and see policy with specim …
Adverse Pathology and Undetectable Ultrasensitive Prostate-Specific Antigen After Radical Prostatectomy: Is Adjuvant Radiation Warranted?RM Simon et al. BJU Int 117 (6), 897-903. PMID 26010251.Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Glea …
Cancer-specific Survival and Predictors of Prostate-Specific Antigen Recurrence and Survival in Patients With Seminal Vesicle Invasion After Radical ProstatectomyFP Secin et al. Cancer 106 (11), 2369-75. PMID 16649221.SVI does not invariably signal BCR or death from cancer in patients who undergo RP and pelvic lymph node dissection. Fifteen years later, approximately 33% of men with SV …
[Diagnostic Problems and Prognostic Factors in Prostate Cancer]M Tarján. Magy Onkol 60 (1), 72-7. PMID 26934354. - ReviewMunkánk célja, hogy hisztológiai módszer segítségével már preoperatív biopsziában el tudjuk különíteni a duktális rákot (DAP) az acináristól (AAP), és hogy igazolni tudju …