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The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer
Background Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectom...
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| Published in: | The Prostate 2019-12, Vol.79 (16), p.1805-1810 |
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| Main Authors: | , , , , , , , |
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| container_issue | 16 |
| container_start_page | 1805 |
| container_title | The Prostate |
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| creator | Jang, Won Sik Koh, Dong Hoon Kim, Jongchan Lee, Jong Soo Chung, Doo Yong Ham, Won Sik Rha, Koon Ho Choi, Young Deuk |
| description | Background
Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC.
Methods
We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan‐Meier methods and Cox proportional hazard models.
Results
Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan‐Meier curves showed significant differences in biochemical recurrence (BCR)‐free survival across the groups (P |
| doi_str_mv | 10.1002/pros.23905 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2284562283</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2311062299</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3575-4493db6227eccbd0cbae91e8642653dd7c3f71de1dd310c4a04e8f94d777b2f03</originalsourceid><addsrcrecordid>eNp9kc1O3DAURq0KVAbaTR-gssSmQgq9_sk4WSLUAhISiNK15dg3Q1BiBzvRaF6gz42nAyxYsLry1dGxP3-EfGNwygD4zzGGdMpFDeUnsmBQqwJAlntkAVxBIZlQB-QwpUeAjAP_TA4Ek5WAJV-Qf_cPSLNg5UOaOku7YTR2oqGlLqz9KhrX-RU13tF5fD21MQy06cKYNnQKdLu1pt9a0mQmtFMYNtQMIaMDerrupgd60aNJwdNkQ0Sq3mBqjbcYv5D91vQJv77MI_L396_788vi-ubi6vzsurCiVGUhZS1cs-RcobWNA9sYrBlWS8mXpXBOWdEq5pA5JxhYaUBi1dbSKaUa3oI4Ij923nz_04xp0kOXLPa98RjmpDmvZJn9lcjo8Tv0MczR59dpLhjLv8frOlMnO8rmQCliq8fYDSZuNAO9bUdvk-r_7WT4-4tybgZ0b-hrHRlgO2Dd9bj5QKVv727-7KTPD1KcZA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2311062299</pqid></control><display><type>article</type><title>The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Jang, Won Sik ; Koh, Dong Hoon ; Kim, Jongchan ; Lee, Jong Soo ; Chung, Doo Yong ; Ham, Won Sik ; Rha, Koon Ho ; Choi, Young Deuk</creator><creatorcontrib>Jang, Won Sik ; Koh, Dong Hoon ; Kim, Jongchan ; Lee, Jong Soo ; Chung, Doo Yong ; Ham, Won Sik ; Rha, Koon Ho ; Choi, Young Deuk</creatorcontrib><description>Background
Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC.
Methods
We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan‐Meier methods and Cox proportional hazard models.
Results
Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan‐Meier curves showed significant differences in biochemical recurrence (BCR)‐free survival across the groups (P < .001). In the multivariate analyses, these groups were significantly associated with BCR (4 + 3/3 + 4: hazard ratio [HR], 1.675; 3 + 4/4 + 3: HR, 1.908; and 4 + 3/4 + 3: HR, 2.699).
Conclusions
Downgrading and upgrading from NB to RP was an independent predictor of BCR in men with GS 7 PC, which could be due to the amount of Gleason pattern 4.</description><identifier>ISSN: 0270-4137</identifier><identifier>EISSN: 1097-0045</identifier><identifier>DOI: 10.1002/pros.23905</identifier><identifier>PMID: 31483062</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; biochemical recurrence ; Biopsy ; Biopsy, Needle ; Cancer surgery ; Disease-Free Survival ; Gleason grade ; Humans ; Kaplan-Meier Estimate ; Male ; Medical records ; Middle Aged ; needle biopsy ; Neoplasm Grading ; Prognosis ; Prostate cancer ; Prostatectomy ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; radical prostatectomy ; Retrospective Studies ; Urological surgery</subject><ispartof>The Prostate, 2019-12, Vol.79 (16), p.1805-1810</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3575-4493db6227eccbd0cbae91e8642653dd7c3f71de1dd310c4a04e8f94d777b2f03</citedby><cites>FETCH-LOGICAL-c3575-4493db6227eccbd0cbae91e8642653dd7c3f71de1dd310c4a04e8f94d777b2f03</cites><orcidid>0000-0001-8588-7584 ; 0000-0001-8614-5742 ; 0000-0003-3954-960X ; 0000-0003-2246-8838 ; 0000-0002-9082-0381 ; 0000-0002-0022-6689 ; 0000-0002-9984-1138 ; 0000-0002-8545-5797</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31483062$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jang, Won Sik</creatorcontrib><creatorcontrib>Koh, Dong Hoon</creatorcontrib><creatorcontrib>Kim, Jongchan</creatorcontrib><creatorcontrib>Lee, Jong Soo</creatorcontrib><creatorcontrib>Chung, Doo Yong</creatorcontrib><creatorcontrib>Ham, Won Sik</creatorcontrib><creatorcontrib>Rha, Koon Ho</creatorcontrib><creatorcontrib>Choi, Young Deuk</creatorcontrib><title>The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer</title><title>The Prostate</title><addtitle>Prostate</addtitle><description>Background
Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC.
Methods
We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan‐Meier methods and Cox proportional hazard models.
Results
Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan‐Meier curves showed significant differences in biochemical recurrence (BCR)‐free survival across the groups (P < .001). In the multivariate analyses, these groups were significantly associated with BCR (4 + 3/3 + 4: hazard ratio [HR], 1.675; 3 + 4/4 + 3: HR, 1.908; and 4 + 3/4 + 3: HR, 2.699).
Conclusions
Downgrading and upgrading from NB to RP was an independent predictor of BCR in men with GS 7 PC, which could be due to the amount of Gleason pattern 4.</description><subject>Aged</subject><subject>biochemical recurrence</subject><subject>Biopsy</subject><subject>Biopsy, Needle</subject><subject>Cancer surgery</subject><subject>Disease-Free Survival</subject><subject>Gleason grade</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>needle biopsy</subject><subject>Neoplasm Grading</subject><subject>Prognosis</subject><subject>Prostate cancer</subject><subject>Prostatectomy</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - surgery</subject><subject>radical prostatectomy</subject><subject>Retrospective Studies</subject><subject>Urological surgery</subject><issn>0270-4137</issn><issn>1097-0045</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kc1O3DAURq0KVAbaTR-gssSmQgq9_sk4WSLUAhISiNK15dg3Q1BiBzvRaF6gz42nAyxYsLry1dGxP3-EfGNwygD4zzGGdMpFDeUnsmBQqwJAlntkAVxBIZlQB-QwpUeAjAP_TA4Ek5WAJV-Qf_cPSLNg5UOaOku7YTR2oqGlLqz9KhrX-RU13tF5fD21MQy06cKYNnQKdLu1pt9a0mQmtFMYNtQMIaMDerrupgd60aNJwdNkQ0Sq3mBqjbcYv5D91vQJv77MI_L396_788vi-ubi6vzsurCiVGUhZS1cs-RcobWNA9sYrBlWS8mXpXBOWdEq5pA5JxhYaUBi1dbSKaUa3oI4Ij923nz_04xp0kOXLPa98RjmpDmvZJn9lcjo8Tv0MczR59dpLhjLv8frOlMnO8rmQCliq8fYDSZuNAO9bUdvk-r_7WT4-4tybgZ0b-hrHRlgO2Dd9bj5QKVv727-7KTPD1KcZA</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Jang, Won Sik</creator><creator>Koh, Dong Hoon</creator><creator>Kim, Jongchan</creator><creator>Lee, Jong Soo</creator><creator>Chung, Doo Yong</creator><creator>Ham, Won Sik</creator><creator>Rha, Koon Ho</creator><creator>Choi, Young Deuk</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TO</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8588-7584</orcidid><orcidid>https://orcid.org/0000-0001-8614-5742</orcidid><orcidid>https://orcid.org/0000-0003-3954-960X</orcidid><orcidid>https://orcid.org/0000-0003-2246-8838</orcidid><orcidid>https://orcid.org/0000-0002-9082-0381</orcidid><orcidid>https://orcid.org/0000-0002-0022-6689</orcidid><orcidid>https://orcid.org/0000-0002-9984-1138</orcidid><orcidid>https://orcid.org/0000-0002-8545-5797</orcidid></search><sort><creationdate>20191201</creationdate><title>The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer</title><author>Jang, Won Sik ; Koh, Dong Hoon ; Kim, Jongchan ; Lee, Jong Soo ; Chung, Doo Yong ; Ham, Won Sik ; Rha, Koon Ho ; Choi, Young Deuk</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3575-4493db6227eccbd0cbae91e8642653dd7c3f71de1dd310c4a04e8f94d777b2f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>biochemical recurrence</topic><topic>Biopsy</topic><topic>Biopsy, Needle</topic><topic>Cancer surgery</topic><topic>Disease-Free Survival</topic><topic>Gleason grade</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>needle biopsy</topic><topic>Neoplasm Grading</topic><topic>Prognosis</topic><topic>Prostate cancer</topic><topic>Prostatectomy</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - surgery</topic><topic>radical prostatectomy</topic><topic>Retrospective Studies</topic><topic>Urological surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jang, Won Sik</creatorcontrib><creatorcontrib>Koh, Dong Hoon</creatorcontrib><creatorcontrib>Kim, Jongchan</creatorcontrib><creatorcontrib>Lee, Jong Soo</creatorcontrib><creatorcontrib>Chung, Doo Yong</creatorcontrib><creatorcontrib>Ham, Won Sik</creatorcontrib><creatorcontrib>Rha, Koon Ho</creatorcontrib><creatorcontrib>Choi, Young Deuk</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The Prostate</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jang, Won Sik</au><au>Koh, Dong Hoon</au><au>Kim, Jongchan</au><au>Lee, Jong Soo</au><au>Chung, Doo Yong</au><au>Ham, Won Sik</au><au>Rha, Koon Ho</au><au>Choi, Young Deuk</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer</atitle><jtitle>The Prostate</jtitle><addtitle>Prostate</addtitle><date>2019-12-01</date><risdate>2019</risdate><volume>79</volume><issue>16</issue><spage>1805</spage><epage>1810</epage><pages>1805-1810</pages><issn>0270-4137</issn><eissn>1097-0045</eissn><abstract>Background
Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC.
Methods
We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan‐Meier methods and Cox proportional hazard models.
Results
Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan‐Meier curves showed significant differences in biochemical recurrence (BCR)‐free survival across the groups (P < .001). In the multivariate analyses, these groups were significantly associated with BCR (4 + 3/3 + 4: hazard ratio [HR], 1.675; 3 + 4/4 + 3: HR, 1.908; and 4 + 3/4 + 3: HR, 2.699).
Conclusions
Downgrading and upgrading from NB to RP was an independent predictor of BCR in men with GS 7 PC, which could be due to the amount of Gleason pattern 4.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31483062</pmid><doi>10.1002/pros.23905</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-8588-7584</orcidid><orcidid>https://orcid.org/0000-0001-8614-5742</orcidid><orcidid>https://orcid.org/0000-0003-3954-960X</orcidid><orcidid>https://orcid.org/0000-0003-2246-8838</orcidid><orcidid>https://orcid.org/0000-0002-9082-0381</orcidid><orcidid>https://orcid.org/0000-0002-0022-6689</orcidid><orcidid>https://orcid.org/0000-0002-9984-1138</orcidid><orcidid>https://orcid.org/0000-0002-8545-5797</orcidid></addata></record> |
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| ispartof | The Prostate, 2019-12, Vol.79 (16), p.1805-1810 |
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| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Aged biochemical recurrence Biopsy Biopsy, Needle Cancer surgery Disease-Free Survival Gleason grade Humans Kaplan-Meier Estimate Male Medical records Middle Aged needle biopsy Neoplasm Grading Prognosis Prostate cancer Prostatectomy Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery radical prostatectomy Retrospective Studies Urological surgery |
| title | The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer |
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