- Email: [email protected]
Re: Prognostic Significance of Percentage and Architectural Types of Contemporary Gleason Pattern 4 Prostate Cancer in Radical Prostatectomy
EURURO-7043; No. of Pages 1 EUROPEAN UROLOGY XXX (2016) XXX–XXX
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Words of Wisdom Re: Prognostic Significance of Percentage and Architectural Types of Contemporary Gleason Pattern 4 Prostate Cancer in Radical Prostatectomy Choy B, Pearce SM, Anderson BB, et al Am J Surg Pathol. In press. http://dx.doi.org/10.1097/PAS. 0000000000000691 Experts’ summary: In this study, the prognostic significance of the percentage of Gleason pattern 4 (%GP4) according to the 2014 International Society of Urological Pathology (ISUP) grading criteria was assessed in radical prostatectomies (RP). Hence, the ISUP 2014 consensus recommended novel grade grouping for prostate cancer that included dividing Gleason Score (GS) 7 into grade groups 2 (GS 3+4) and 3 (GS 4+3). Results showed that multivariable Cox proportional hazards regression model for factors associated with 5-yr biochemical recurrence (BCR)free survival rates among GS 7 cancers identified a mainly positive surgical margin (hazard ratio [HR] 2.70, p < 0.01), %GP4 (21–50% [HR 2.21], 51–70% [HR 2.59], >70% [HR 6.57], all p < 0.01) as independent predictors. Experts’ comments: Therefore, it is well established that beyond novel grade grouping, the continuous spectrum of absolute %GP4 aids in the prediction for BCR or risk of lymph node (LN) metastasis. Should %GP4 be part of path reports along with novel grade grouping? Routinely or prospectively in study protocols? The answer may be yes. Hence, several studies showed that dichotomization of GS7 may oversimplify the continuous spectrum of absolute %GP4 or even GP4/5 (from 10%, 20%, to 90%). Rubin et al [1] showed that prognostic groups GS8 (4+4) and GS >8 (with GP5) exhibit genomic similarity. If %GP4/5 and the largest cancer volume [2] in RP are one of the strongest predictors of prostate cancer progression and a valid measure of cancer severity, the absolute volume of the GP4/5 carcinoma (cancer volume %GP 4/5) was demonstrated to be even stronger. In 1990, McNeal et al [3] noted that the volume of GP4/5 carcinoma on RP was a strong independent predictor of LN metastasis. Addition of cribriform cancer (% or volume; GP3 before 2014 ISUP grading criteria) increased the predictive power for several combinations of variables. The absolute
volume of the GP4/5 threshold was equal to 3.2 cc; out of 209 largest cancers in RP, there was only one carcinoma with LN metastasis among 171 cancers having less than 3.2 cc of GP4/5 cancer versus 22 of 38 above this threshold of 3.2 cc. What about pretherapeutic evaluation of %GP4/5 carcinoma and tumor volume? Rubin et al [4] and Cole et al [5] observed a weak correlation of %GP4/5 carcinoma on biopsy and RP (r2 = 0.32), and of BCR prediction (HR 1.02, confidence interval 1.01–1.03), respectively. However, it was before the magnetic resonance imaging era and currently tumor grade and volume assessment by magnetic resonance imaging-targeted biopsies is dramatically improved. It still has to be validated. Conflicts of interest: The authors have nothing to disclose.
References [1] Rubin MA, Gireli G, Demichelis F. Genomic correlates to the newly proposed grading prognostic groups for prostate cancer. Eur Urol 2016;69:557–60. [2] Shin SJ, Park CK, Park SY, et al. Total intraglandular and index tumor volumes predict biochemical recurrence in prostate cancer. Virchows Arch 2016;469:305–12. [3] McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA. Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate. Cancer 1990;66:1225–33. [4] Rubin MA, Mucci NR, Manley S, et al. Predictors of Gleason pattern 4/5 prostate cancer on prostatectomy specimens: can high grade tumor be predicted preoperatively? J Urol 2001;165:114–8. [5] Cole AI, Morgan TM, Spratt DE, et al. Prognostic value of percent Gleason Grade 4 at prostate biopsy in predicting prostatectomy pathology and recurrence. J Urol 2016;196:405–11. Arnauld Villersa,*, Mark A. Rubinb a b
Department of Urology, Lille University, Lille, France
Englander Institute for Precision Medicine, Weill Cornell Medicine,
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA *Corresponding author. Department of Urology, Lille University, CHRU F-59000 Lille, France. E-mail address: [email protected] (A. Villers).
http://dx.doi.org/10.1016/j.eururo.2016.09.017 0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Words of Wisdom Re: Prognostic Significance of Percentage and Architectural Types of Contemporary Gleason Pattern 4 Prostate Cancer in Radical Prostatectomy Choy B, Pearce SM, Anderson BB, et al Am J Surg Pathol. In press. http://dx.doi.org/10.1097/PAS. 0000000000000691 Experts’ summary: In this study, the prognostic significance of the percentage of Gleason pattern 4 (%GP4) according to the 2014 International Society of Urological Pathology (ISUP) grading criteria was assessed in radical prostatectomies (RP). Hence, the ISUP 2014 consensus recommended novel grade grouping for prostate cancer that included dividing Gleason Score (GS) 7 into grade groups 2 (GS 3+4) and 3 (GS 4+3). Results showed that multivariable Cox proportional hazards regression model for factors associated with 5-yr biochemical recurrence (BCR)free survival rates among GS 7 cancers identified a mainly positive surgical margin (hazard ratio [HR] 2.70, p < 0.01), %GP4 (21–50% [HR 2.21], 51–70% [HR 2.59], >70% [HR 6.57], all p < 0.01) as independent predictors. Experts’ comments: Therefore, it is well established that beyond novel grade grouping, the continuous spectrum of absolute %GP4 aids in the prediction for BCR or risk of lymph node (LN) metastasis. Should %GP4 be part of path reports along with novel grade grouping? Routinely or prospectively in study protocols? The answer may be yes. Hence, several studies showed that dichotomization of GS7 may oversimplify the continuous spectrum of absolute %GP4 or even GP4/5 (from 10%, 20%, to 90%). Rubin et al [1] showed that prognostic groups GS8 (4+4) and GS >8 (with GP5) exhibit genomic similarity. If %GP4/5 and the largest cancer volume [2] in RP are one of the strongest predictors of prostate cancer progression and a valid measure of cancer severity, the absolute volume of the GP4/5 carcinoma (cancer volume %GP 4/5) was demonstrated to be even stronger. In 1990, McNeal et al [3] noted that the volume of GP4/5 carcinoma on RP was a strong independent predictor of LN metastasis. Addition of cribriform cancer (% or volume; GP3 before 2014 ISUP grading criteria) increased the predictive power for several combinations of variables. The absolute
volume of the GP4/5 threshold was equal to 3.2 cc; out of 209 largest cancers in RP, there was only one carcinoma with LN metastasis among 171 cancers having less than 3.2 cc of GP4/5 cancer versus 22 of 38 above this threshold of 3.2 cc. What about pretherapeutic evaluation of %GP4/5 carcinoma and tumor volume? Rubin et al [4] and Cole et al [5] observed a weak correlation of %GP4/5 carcinoma on biopsy and RP (r2 = 0.32), and of BCR prediction (HR 1.02, confidence interval 1.01–1.03), respectively. However, it was before the magnetic resonance imaging era and currently tumor grade and volume assessment by magnetic resonance imaging-targeted biopsies is dramatically improved. It still has to be validated. Conflicts of interest: The authors have nothing to disclose.
References [1] Rubin MA, Gireli G, Demichelis F. Genomic correlates to the newly proposed grading prognostic groups for prostate cancer. Eur Urol 2016;69:557–60. [2] Shin SJ, Park CK, Park SY, et al. Total intraglandular and index tumor volumes predict biochemical recurrence in prostate cancer. Virchows Arch 2016;469:305–12. [3] McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA. Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate. Cancer 1990;66:1225–33. [4] Rubin MA, Mucci NR, Manley S, et al. Predictors of Gleason pattern 4/5 prostate cancer on prostatectomy specimens: can high grade tumor be predicted preoperatively? J Urol 2001;165:114–8. [5] Cole AI, Morgan TM, Spratt DE, et al. Prognostic value of percent Gleason Grade 4 at prostate biopsy in predicting prostatectomy pathology and recurrence. J Urol 2016;196:405–11. Arnauld Villersa,*, Mark A. Rubinb a b
Department of Urology, Lille University, Lille, France
Englander Institute for Precision Medicine, Weill Cornell Medicine,
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA *Corresponding author. Department of Urology, Lille University, CHRU F-59000 Lille, France. E-mail address: [email protected] (A. Villers).
http://dx.doi.org/10.1016/j.eururo.2016.09.017 0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.