Evaluation of Gleason Grade Group 5 in a Contemporary Prostate Cancer Grading System and Literature Review |
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| Authors: | Rei Kamitani Kazuhiro Matsumoto Takeo Kosaka Toshikazu Takeda Akinori Hashiguchi Nobuyuki Tanaka Shinya Morita Ryuichi Mizuno Toshiaki Shinojima Hiroshi Asanuma Mototsugu Oya |
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| Affiliation: | 1. Department of Urology, Keio University School of Medicine, Tokyo, Japan;2. Department of Pathology, Keio University School of Medicine, Tokyo, Japan;1. Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;2. Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China;1. Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR;2. Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR;3. Department of Biostatics, University of Arkansas for Medical Sciences, Little Rock, AR;4. Department of Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, FL;5. Department of Internal Medicine, Loma Linda University, Loma Linda, CA;6. Department of Radiation Oncology, Memorial Health, Savannah, GA;7. Department of Radiation Oncology, Rush University Medical Center, Chicago, IL;1. Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;2. Department of Medical Oncology, Sasaki Foundation Kyoundo Hospital, Tokyo, Japan;1. Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), Erlangen, Germany;2. Department of Urology, University Hospital Muenster, Muenster, Germany;3. Immune Cooperativ Oncology Group (ICOG) of the Comprehensive Cancer Center Lower-Saxoney (CCC-N), Hannover Medical School, Hannover, Germany;4. Department of Urology, University Hospital Göttingen, Göttingen, Germany;5. Department of Pathology, University Hospital Göttingen, Göttingen, Germany;6. Department of Urology and Pediatric Urology, University of Saarland (UKS), Homburg, Germany;7. Department of Urology, University of Marburg, Marburg, Germany;8. Department of Urology, University Hospital Munich, Munich, Germany;9. Department of Urology, University Hospital Heidelberg, Heidelberg, Germany;10. Institute of Pathology, University Hospital Mainz, Mainz, Germany;11. Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University (FAU), Erlangen, Germany;12. Department of Urology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany;13. Department of Urology, University of Mainz, Mainz, Germany;14. Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany;15. Department of Urology, University of Regensburg, Regensburg, Germany;16. Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany;1. Division of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy;2. Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy;3. Department of Cancer Medicine, Gustave Roussy Cancer Campus, Paris-SudUniversity, Villejuif, France;4. Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy;1. Department of Urology, University of Munich, Munich, Germany;2. Department of Internal Medicine III, University of Munich, Munich, Germany;3. Comprehensive Cancer Center München, Munich, Germany |
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| Abstract: | IntroductionThe aim of this study was to validate contemporary grading systems, in particular, the Gleason grade group (GGG) 5.Patients and MethodsWe retrospectively reviewed the clinicopathologic data of 176 patients who underwent radical prostatectomy and whose pathologic results were GGG 4 or 5. The endpoints were biochemical recurrence (BCR) and castration-resistant prostate cancer (CRPC).ResultsThe GGG 4 group was composed of 69 patients. The GGG 5 group consisted of 78 patients with GS 4+5 and 29 patients with GS 5+4 or higher. The 5-year BCR-free survival rates for men with GGG 4, GS 4+5, and GS 5+4 or higher were 59%, 54%, and 20%, respectively, and the 5-year CRPC-free survival rates were 98%, 100%, and 88%, respectively. Both the BCR- and CRPC-free survival rates were significantly higher in GS 4+5 than in GS 5+4 or higher (P < .001 and P = .002, respectively), but there were no significant differences between GGG 4 and GS 4+5 (P = .702 and P = .803, respectively). The multivariate analysis demonstrated that GS 5+4 or higher (hazard ratio, 3.4; P = .002) and lymphovascular invasion (hazard ratio, 3.4; P < .001) greatly affected BCR.ConclusionOur follow-up study revealed that men with GS 4+5 and those with GGG 4 had a similar prognosis. However, there was a significant discrepancy in prognosis between GS 4+5 and GS 5+4 or higher. This suggested that GGG 4 and 5 in the contemporary prostate cancer grading system should be reviewed. Furthermore, lymphovascular invasion may be useful to subgroup these pathologically high-risk patients. |
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| Keywords: | Biochemical recurrence Castration-resistant prostate cancer Gleason score Grade group High-risk prostate cancer |
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