Biopsy Gleason pattern 5 tied to recurrence, metastasis, mortality in high-risk prostate cancer
Preoperative biopsy Gleason grade (4 + 4 vs any Gleason pattern 5) subclassification of high-risk prostate cancer identifies men at highest risk for progression, according to a study. Furthermore, any Gleason 5 on biopsy correlates with a higher risk of metastasis, as well as prostate cancer-specific and overall mortality.
The authors assessed men with biopsy Gleason sum 8-10 prostate cancer treated with radical prostatectomy. The patients were divided into those with Gleason 4 + 4 vs those with any pattern 5 (ie, Gleason 3 + 5, 5 + 3, 4 + 5, 5 + 4 or 5 + 5).
Kaplan-Meier, log rank test and Cox proportional hazards models were used to analyse the predictors of biochemical recurrence, metastases, and prostate cancer-specific and overall survival.
A total of 634 men at high risk were identified. Of these, 394 (62 percent) had Gleason 4 + 4 and 240 (38 percent) had Gleason pattern 5 on biopsy. There was no significant difference in baseline characteristics between the groups.
Multivariable analysis revealed that men at high risk with Gleason pattern 5 vs Gleason 4 + 4 had no difference in the risk of biochemical recurrence (hazard ratio [HR], 1.26; 95 percent CI, 0.99 to 1.61; p=0.065). However, patients with any Gleason 5 on biopsy had significantly higher risk for metastasis (HR, 2.55; 1.50 to 4.35; p=0.001), prostate cancer-specific mortality (HR, 2.67; 1.26 to 5.66; p=0.010) and overall mortality (HR, 1.60; 1.09 to 2.34; p=0.016).
“Grouping all Gleason 8-10 tumours together as high-risk lesions may fail to fully stratify men at highest risk for poor outcomes,” according to researchers.