The pathological grade of prostate cancer is the strongest predictor of recurrence. It is unclear whether the better predictor is the composite of all carcinomas within the prostate, or the highest grade lesion (index). The purpose of this study was to determine whether composite or index grade group better predicts biochemical recurrence (BCR).
We undertook a retrospective analysis from a prospective institutional cohort study of men who underwent radical prostatectomy for localised prostate cancer between 2009 and 2020, in which an index and composite grade group was reported. The index grade in this study was defined as the highest grade of any tumour, usually with the highest stage, regardless of volume. Multivariate analysis and Kaplan–Meier plots were utilised.
A total of 2024 men underwent radical prostatectomy during the study period; we analysed 1605 with composite grade group 2 or 3 prostate cancer. Median preoperative prostate specific antigen (PSA) was 5.9 ng/L, mean follow up was 56.8 months, 54% were pT2, 76% had multifocal disease and 16% had discordant index and composite grades.
Patients with discordant index grade group had a higher risk of BCR [hazard ratio (HR) 2.22, p<0.0001]. The prevalence of BCR in the discordant group was higher at 1, 3, 5 and 7 years (4.7% vs 8.9%, 8.3% vs 18.1%, 14.5% vs 28.8% and 22.5% vs 49.5%, respectively).
In cases of discordance, a higher index grade group is associated with increased rates of BCR after radical prostatectomy. Index rather than composite grade group should be used to counsel men post-operatively regarding prognosis and follow-up.
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- Recent global patterns in prostate cancer incidence and mortality rates.Eur Urol. 2020; 77: 38-52
- Contemporary grading for prostate cancer: implications for patient care.Eur Urol. 2013; 63: 892-901
- Controversial issues in Gleason and International Society of Urological Pathology (ISUP) prostate cancer grading: proposed recommendations for international implementation.Pathology. 2019; 51: 463-473
- Re-evaluating the concept of “dominant/index tumor nodule” in multifocal prostate cancer.Virchows Arch. 2014; 464: 589-594
- The 2019 International Society of Urological Pathology (ISUP) Consensus conference on grading of prostatic carcinoma.Am J Surg Pathol. 2020; 44: e87-e99
- Heterogeneity of Gleason grade in multifocal adenocarcinoma of the prostate.Cancer. 2004; 100: 2362-2366
- Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers.J Urol. 2003; 170: 459-463
- The index lesion and the origin of prostate cancer.N Engl J Med. 2009; 361: 1704-1706
- Selection for focal therapy: is it too early to judge?.Eur Urol. 2014; 66: 20-21
- Frequent clonal relations between metastases and non-index prostate cancer lesions.JCI Insight. 2019; 4e124756
- Prostate cancer grading: a decade after the 2005 modified Gleason grading system.Arch Pathol Lab Med. 2016; 140: 1140-1152
- The 2019 Genitourinary Pathology Society (GUPS) white paper on contemporary grading of prostate cancer.Arch Pathol Lab Med. 2021; 145: 461-493
- The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy.J Clin Oncol. 2005; 23: 2911-2917
- Grading of multifocal prostate cancer cases in which the largest volume and the highest grade do not coincide within one lesion.J Urol. 2021; 206: 338-345
- Tumor focality does not predict biochemical recurrence after radical prostatectomy in men with clinically localized prostate cancer.J Urol. 2011; 186: 506-510
- Clinicopathological behavior of single focus prostate adenocarcinoma.J Urol. 2009; 182: 2689-2694
- The risk of biochemical recurrence for intermediate-risk prostate cancer after radical prostatectomy.Scand J Urol. 2017; 51: 450-456
- Five year biochemical recurrence free survival for intermediate risk prostate cancer after radical prostatectomy, external beam radiation therapy or permanent seed implantation.Urology. 2010; 76: 1251-1257
- Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer.J Clin Oncol. 1999; 17: 1499-1507
- Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy.J Clin Oncol. 2005; 23: 7005
- Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non-inferiority trial.Lancet Oncol. 2020; 21: 1331-1340
- RADICALS (radiotherapy and androgen deprivation in combination after local surgery).Clin Oncol. 2007; 19: 167-171
- Prostate biopsy and radical prostatectomy Gleason score correlation in heterogenous tumors.Am J Surg Pathol. 2015; 39: 1213-1218
- MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis.N Engl J Med. 2020; 382: 917-928
Published online: January 30, 2023
Accepted: October 24, 2022
Received in revised form: October 19, 2022
Received: September 12, 2022
Publication stageIn Press Corrected Proof
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