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01-02-2012 | Original Article

Should we abstain from Gleason score 2–4 in the diagnosis of prostate cancer? Results of a German multicentre study

Authors: Sabine Brookman-May, Matthias May, Wolf-Ferdinand Wieland, Steffen Lebentrau, Sven Gunia, Stefan Koch, Christian Gilfrich, Jan Roigas, Bernd Hoschke, Maximilian Burger

Published in: World Journal of Urology | Issue 1/2012

Abstract

Purpose

The present study analysed the loss of prognostic information related to the abandonment of Gleason score (GS) 2–4 by the International Society of Urological Pathology (ISUP-2005).

Methods

Within a 10-year period prior to the modification of GS, 856 patients (mean age 64.2 years) underwent radical prostatectomy (RP). The grade of agreement between GS in biopsy and definitive histology was calculated by Kappa statistics (κ). Univariable and multivariable influence of different preoperatively available parameters on disease-free survival (DFS) were assessed. The mean follow-up period was 39 months.

Results

Concordance between GS in biopsy versus RP samples was 58% (κ-value 0.354) and was improved by an increased number of biopsy cores. Undergrading in biopsy was present in 38% and not significantly enhanced by an extended time-period between biopsy and RP (threshold 90d). PSA level, clinical tumour stage, fraction of positive cores (dichotomized at 34%), cases of RP per year and institution (dichotomized at 75), and GS independently influenced DFS. An upgrading to GS ≥ 7 was found in only 5.7% of patients presenting with GS 2–4 in the biopsy. Independent from definitive histology, patients with GS 2–4 had a significantly better prognosis compared to patients with a higher GS.

Conclusions

The present study shows an independent prognostic impact of GS in biopsy samples classified according to the previous classification. The elimination of GS 2–4 by the ISUP 2005 results in a considerable loss of pretherapeutic prognostic information and therefore should be questioned in particular with regard to the increasing demand for active surveillance regimens.

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Title: Should we abstain from Gleason score 2–4 in the diagnosis of prostate cancer? Results of a German multicentre study
Authors: Sabine Brookman-May
Matthias May
Wolf-Ferdinand Wieland
Steffen Lebentrau
Sven Gunia
Stefan Koch
Christian Gilfrich
Jan Roigas
Bernd Hoschke
Maximilian Burger
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 1/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-010-0632-5

At a glance: The STEP trials

Springer Medicine

Should we abstain from Gleason score 2–4 in the diagnosis of prostate cancer? Results of a German multicentre study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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