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True Incidence of Gleason 6 Pathology in Patients with Metastatic Castration Resistant Prostate Cancer (mCRPC)

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Abstract

Introduction

Recent evidence from histology studies regarding random prostate biopsies hint toward a relationship between higher biopsy Gleason score and the development of metastatic castration resistant prostate cancer (mCRPC). However, prostate biopsy underestimates final pathology in about one-third of patients. We evaluated the final whole gland pathology from radical prostatectomy exclusively in order to assess the true risk of progressing to the mCRPC state for patients with confirmed Gleason ≤6 prostate cancer.

Methods

Patients with confirmed mCRPC from our outpatient clinic were retrospectively evaluated with regard to whole gland pathology and the occurrence of Gleason 6 histology from 1995 to 2015. Conversely, patients with confirmed Gleason 6 pathology from our institutional database were followed up for the development of mCRPC from 2001 to 2015. Kaplan–Meier analysis and the log rank test were applied for survival analysis. The binomial test was used to evaluate occurrence rates of Gleason ≤6 pathologies in mCRPC patients.

Results

Out of 62 patients with mCRPC none had confirmed Gleason 6 pathology on whole gland histology of the prostate. Out of 86 patients with confirmed Gleason 6 pathology none developed an mCRPC over the follow-up period.

Conclusion

The development of mCRPC in patients with true Gleason 6 pathology is very rare and could not be confirmed in our series. This finding may have important implications in future treatment planning.

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Acknowledgements

No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Alena Böker and Katharina Krüger have nothing to disclose. Markus A. Kuczyk: Honoraria and speaker for Astellas, Bayer, BMS, Eisai, Janssen, Novartis, Pfizer, and Pierre Fabre. Advisor for BMS, Eisai, Farco-Pharma, Pfizer, and Storz. Mario W. Kramer: Honoraria and speaker for Astellas, Bayer, Pierre Fabre, Eisai, Roche, Pfizer, Sanofi, and Novartis. Axel S. Merseburger: Honoraria and speaker for Amgen, Astellas, Bayer, Ferring, Hexal, Ipsen, Janssen, Novartis, Roche, TEVA, and Sanofi. Florian Imkamp: Honoraria and travel grants from Baxter, Astellas, Pfizer, Novartis, and Pierre Fabre. Christoph-A. von Klot: Honoraria and speaker for Janssen, Astellas, Bayer, BMS, Ipsen, Novartis, and TEVA.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors. The authors acknowledge Marina Akkermann, Nadja Bergen, and Gerd Wegener for excellent patient and database assistance.

Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available since some individual therapeutic and clinical data may identify patients in a relatively small series from a single institute but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Urology and Urological Oncology, Hannover University Medical School, Hannover, Germany

    Alena Böker, Markus A. Kuczyk, Katharina Krüger, Florian Imkamp & Christoph A. von Klot

  2. Department of Urology, Campus Lübeck University Hospital Schleswig–Holstein, Lübeck, Germany

    Mario W. Kramer & Axel S. Merseburger

Authors
  1. Alena Böker
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  2. Markus A. Kuczyk
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  4. Axel S. Merseburger
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  5. Katharina Krüger
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  6. Florian Imkamp
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  7. Christoph A. von Klot
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Corresponding author

Correspondence to Christoph A. von Klot.

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Böker, A., Kuczyk, M.A., Kramer, M.W. et al. True Incidence of Gleason 6 Pathology in Patients with Metastatic Castration Resistant Prostate Cancer (mCRPC). Adv Ther 34, 171–179 (2017). https://doi.org/10.1007/s12325-016-0450-2

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  • DOI: https://doi.org/10.1007/s12325-016-0450-2

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