Should all prostate needle biopsy Gleason score 4 + 4 = 8 prostate cancers be high risk? Implications for shared decision-making and patient counselling

Kevin Ginsburg, Adam I. Cole, Michael E. Silverman, Joan Livingstone, Daryn W. Smith, Lance K. Heilbrun, Dongping Shi, Rohit Mehra, Wael A. Sakr, Todd M. Morgan, Michael L. Cher

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objectives: To estimate the probability of downgrading to Gleason score ≤7 at radical prostatectomy for men with a prostate needle biopsy demonstrating Gleason score 8 (4 + 4). Methods: This is a retrospective review of men with Gleason score 8 (4 + 4) prostate cancer on needle biopsy who then underwent a radical prostatectomy at the Karmanos Cancer Institute or the University of Michigan. Men with any pattern 5 on the diagnostic biopsy were excluded. The objective was to estimate the proportion of patients whose tumors were downgraded to Gleason score ≤7 at radical prostatectomy and to identify clinical and biopsy parameters associated with downgrading. Results: Median age of our cohort was 63 years (IQR: 59, 67.5) and median follow-up was 15 months (IQR: 7, 37). Of the 105 men that met inclusion criteria, 59% (62/105) were downgraded to Gleason score ≤7 at radical prostatectomy. Having ≤2 cores demonstrating Gleason score 8, ≤50% maximal tumor involvement of any individual core positive for Gleason score 8, or the presence of Gleason pattern 3 (such as 3 + 4, 4 + 3, or 3 + 3) in other biopsy cores were all independently associated with downgrading in our multivariable model. Depending on the absence, presence, or combination of these 3 factors, patients had an estimated 6% to 82% probability of having their tumor downgraded at radical prostatectomy. Conclusions: Men with low volume Gleason 8 (4 + 4) and/or the presence Gleason pattern 3 on prostate needle biopsy often have their tumors downgraded at radical prostatectomy. The presence of these preoperative biopsy parameters could affect pretreatment counseling and impact patient management.

Original languageEnglish
Pages (from-to)78.e1-78.e6
JournalUrologic Oncology: Seminars and Original Investigations
Volume38
Issue number3
DOIs
StatePublished - Mar 2020
Externally publishedYes

Keywords

  • Prostate biopsy
  • Prostate cancer
  • Radical prostatectomy
  • Risk stratification

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