Should all prostate needle biopsy Gleason score 4 + 4 = 8 prostate cancers be high risk? Implications for shared decision-making and patient counselling.
Should all prostate needle biopsy Gleason score 4 + 4 = 8 prostate cancers be high risk? Implications for shared decision-making and patient counselling.: To estimate the probability of downgrading to Gleason score ≤7 at radical prostatectomy for men with a prostate needle biopsy demonstrating Gleason score 8 (4 + 4).This is a retrospective review of men with Gleason score 8 (4 + 4) prostate cancer on needle biopsy who then underwent a radical prostatectomy at the Karmanos Cancer Institute or the University of Michigan.
To estimate the probability of downgrading to Gleason score ≤7 at
radical prostatectomy for men with a prostate needle biopsy
demonstrating Gleason score 8 (4 + 4).
This is a retrospective
review of men with Gleason score 8 (4 + 4) prostate cancer on needle
biopsy who then underwent a radical prostatectomy at the Karmanos Cancer
Institute or the University of Michigan.
Men with any pattern 5 on the
diagnostic biopsy were excluded. The objective was to estimate the
proportion of patients whose tumors were downgraded to Gleason score ≤7
at radical prostatectomy and to identify clinical and biopsy parameters
associated with downgrading.
Median age of our cohort was 63 years
(IQR: 59, 67.5) and median follow-up was 15 months (IQR: 7, 37). Of the
105 men that met inclusion criteria, 59% (62/105) were downgraded to
Gleason score ≤7 at radical prostatectomy. Having ≤2 cores demonstrating
Gleason score 8, ≤50% maximal tumor involvement of any individual core
positive for Gleason score 8, or the presence of Gleason pattern 3 (such
as 3 + 4, 4 + 3, or 3 + 3) in other biopsy cores were all independently
associated with downgrading in our multivariable model. Depending on
the absence, presence, or combination of these 3 factors, patients had
an estimated 6% to 82% probability of having their tumor downgraded at
radical prostatectomy.
Men with low volume Gleason 8 (4 + 4)
and/or the presence Gleason pattern 3 on prostate needle biopsy often
have their tumors downgraded at radical prostatectomy. The presence of
these preoperative biopsy parameters could affect pretreatment
counseling and impact patient management.
Urologic oncology. 2019 Nov 29 [Epub ahead of print]
Kevin
Ginsburg, Adam I Cole, Michael E Silverman, Joan Livingstone, Daryn W
Smith, Lance K Heilbrun, Dongping Shi, Rohit Mehra, Wael A Sakr, Todd M
Morgan, Michael L Cher
Wayne State University, Department of Urology, Detroit, MI. Electronic address: keginsbu@med.wayne.edu.,
University of Michigan, Department of Urology, Ann Arbor, MI., Wayne
State University, School of Medicine, Detroit MI., Karmanos Cancer
Institute, Detroit, MI., Wayne State University, Department of Oncology,
Detroit, MI., Wayne State University, Department of Pathology, Detroit,
MI., University of Michigan, Department of Pathology, Ann Arbor, MI.,
Wayne State University, Department of Urology, Detroit, MI.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/31791703
urotoday.com
Should all prostate needle biopsy Gleason
Should all prostate needle biopsy Gleason
score 4 + 4 = 8 prostate cancers be high risk? Implications for shared
decision-making and patient counselling.
To estimate the probability of downgrading to Gleason score ≤7 at
radical prostatectomy for men with a prostate needle biopsy
demonstrating Gleason score 8 (4 + 4).
This is a retrospective
review of men with Gleason score 8 (4 + 4) prostate cancer on needle
biopsy who then underwent a radical prostatectomy at the Karmanos Cancer
Institute or the University of Michigan.
Men with any pattern 5 on the
diagnostic biopsy were excluded. The objective was to estimate the
proportion of patients whose tumors were downgraded to Gleason score ≤7
at radical prostatectomy and to identify clinical and biopsy parameters
associated with downgrading.
Median age of our cohort was 63 years
(IQR: 59, 67.5) and median follow-up was 15 months (IQR: 7, 37). Of the
105 men that met inclusion criteria, 59% (62/105) were downgraded to
Gleason score ≤7 at radical prostatectomy. Having ≤2 cores demonstrating
Gleason score 8, ≤50% maximal tumor involvement of any individual core
positive for Gleason score 8, or the presence of Gleason pattern 3 (such
as 3 + 4, 4 + 3, or 3 + 3) in other biopsy cores were all independently
associated with downgrading in our multivariable model. Depending on
the absence, presence, or combination of these 3 factors, patients had
an estimated 6% to 82% probability of having their tumor downgraded at
radical prostatectomy.
Men with low volume Gleason 8 (4 + 4)
and/or the presence Gleason pattern 3 on prostate needle biopsy often
have their tumors downgraded at radical prostatectomy. The presence of
these preoperative biopsy parameters could affect pretreatment
counseling and impact patient management.
Urologic oncology. 2019 Nov 29 [Epub ahead of print]
Kevin
Ginsburg, Adam I Cole, Michael E Silverman, Joan Livingstone, Daryn W
Smith, Lance K Heilbrun, Dongping Shi, Rohit Mehra, Wael A Sakr, Todd M
Morgan, Michael L Cher
Wayne State University, Department of Urology, Detroit, MI. Electronic address: keginsbu@med.wayne.edu.,
University of Michigan, Department of Urology, Ann Arbor, MI., Wayne
State University, School of Medicine, Detroit MI., Karmanos Cancer
Institute, Detroit, MI., Wayne State University, Department of Oncology,
Detroit, MI., Wayne State University, Department of Pathology, Detroit,
MI., University of Michigan, Department of Pathology, Ann Arbor, MI.,
Wayne State University, Department of Urology, Detroit, MI.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/31791703
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