Presence of biopsy Gleason pattern 5 + 3 is associated with higher mortality after radical prostatectomy but not after external beam radiotherapy compared to other Gleason Grade Group IV patterns+

Christoph Würnschimmel, Mike Wenzel, Francesco Chierigo, Rocco S. Flammia, Keiichiro Mori, Zhe Tian, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Nazareno Suardi, Carlo Terrone, Michele Gallucci, Felix K.H. Chun, Derya Tilki, Markus Graefen, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We hypothesized that Gleason Grade Group (GGG) IV patients treated with radical prostatectomy (RP) or external beam radiotherapy (EBRT) exhibit different cancer-specific mortality (CSM) rates according to underlying Gleason patterns (GP): 4 + 4 versus 3 + 5 versus 5 + 3. Materials and Methods: We identified all GGG IV patients treated with either RP or EBRT within the Surveillance, Epidemiology, and End Results 2004–2016 database. The effect of biopsy GP on CSM (3 + 5 vs. 4 + 4 vs. 5 + 3) was tested in Kaplan–Meier and multivariable competing risks regression models (adjusted for PSA, age at diagnosis, cT-, and cN-stage). Results: Of 26,458 GGG IV patients, 14,203 (53.7%) were treated with EBRT and 12,255 (46.3%) with RP. Of RP patients, 15.3 versus 81.2 versus 3.4% exhibited biopsy GP 3 + 5 versus 4 + 4 versus 5 + 3 and respective 10-year CSM rates were 6.5 versus 6.2 versus 12.6% (p <.001). In multivariable analyses addressing RP patients, GP 5 + 3 was associated with two-fold higher CSM rate than GP 4 + 4 (p <.001), but not GP 3 + 5 (p =.1). Of EBRT patients, 7.6 versus 89.8 versus 2.6% exhibited biopsy GP 3 + 5 versus 4 + 4 versus 5 + 3 and respective 10-year CSM rates were 12.2 versus 13.8 versus 17.8% (p <.001). In multivariable analyses addressing EBRT patients, no CSM differences according to GP were observed (all p ≥.4). Conclusion: In GGG IV RP candidates, the presence of biopsy GP 5 + 3 purports a significantly higher CSM than in GP 4 + 4 or 3 + 5. In GGG IV EBRT candidates, no significant CSM differences according to GP were recorded.

Original languageEnglish
JournalProstate
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Gleason 8
  • Gleason grade group 4, 4+4, 3+5, 5+3
  • high risk
  • prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

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