Skip to main content
SpringerLink
Log in

Clinical Research

The biopsy Gleason score 3+4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3+3: looking for larger selection criteria for active surveillance candidates

  • Original Article
  • Published:
Prostate Cancer and Prostatic Diseases Submit manuscript

Abstract

Background:

To assess whether the addition of clinical Gleason score (Gs) 3+4 to the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria affects pathologic results in patients who are potentially suitable for active surveillance (AS) and to identify possible clinical predictors of unfavourable outcome.

Methods:

Three hundred and twenty-nine men who underwent radical prostatectomy with complete clinical and follow-up data and who would have fulfilled the inclusion criteria of the PRIAS protocol at the time of biopsy except for the addition of biopsy Gs=3+4 and with at least 10 cores taken have been evaluated. One experienced genitourinary pathologist selected those with real Gs=3+3 and 3+4 in only one core according to the 2005 International Society of Urological Pathology criteria. The primary end point was the proportion of unfavourable outcome (nonorgan confined disease or Gs⩾4+3). Logistic regressions explored the association between preoperative characteristics and the primary end point.

Results:

Two hundred and four patients were evaluated and 46 (22.5%) patients harboured unfavourable disease at final pathology. After a median follow-up of 73.5 months, there was no cancer-specific death, and 4 (2.0%) patients had biochemical relapse. There were no significant differences in terms of high Gs, locally advanced disease, unfavourable disease and biochemical relapse-free survival among patients with clinical Gs=3+3 vs Gs=3+4. At multivariable analysis, the presence of atypical small acinar proliferation (ASAP) and lower number of core taken were independently associated with a higher risk of unfavourable disease.

Conclusion:

The inclusion of Gs=3+4 in patients suitable to AS does not enhance the risk of unfavourable disease after radical prostatectomy. Additional factors such as number of cores taken and the presence of ASAP should be considered in patients suitable for AS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A . Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 2010; 28: 126–131.

    Article  PubMed  Google Scholar 

  2. Van den Bergh RC, Roemeling S, Roobol MJ, Roobol W, Schröder FH, Bangma CH . Prospective validation of active surveillance in prostate cancer: the PRIAS study. Eur Urol 2007; 52: 1560–1563.

    Article  PubMed  Google Scholar 

  3. Iremashvili V, Pelaez L, Manoharan M, Jorda M, Rosenberg DL, Soloway MS . Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur Urol 2012; 62: 462–468.

    Article  PubMed  Google Scholar 

  4. Villa L, Salonia A, Capitanio U, Scattoni V, Abdollah F, Suardi N et al. The number of cores at first biopsy may suggest the need for a confirmatory biopsy in patients eligible for active surveillance—implication for clinical decision making in the real-life setting. Urology 2014; 84: 634–641.

    Article  PubMed  Google Scholar 

  5. Dall’Era MA, Albertsen PC, Bangma C, Carroll PR, Carter HB, Cooperberg MR et al. Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol 2012; 62: 976–983.

    Article  PubMed  Google Scholar 

  6. Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL ISUP Grading Committee. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005; 29: 1228–1242.

    Article  PubMed  Google Scholar 

  7. Giunchi F, Brunocilla E, Borghesi M, Rizzi S, Ricci MS, Romagnoli D et al. Revised Gleason grading system is a better predictor of indolent prostate cancer at the time of diagnosis: retrospective clinical-pathological study on matched biopsy and radical prostatectomy specimens. Clin Genitourin Cancer 2014; 12: 325–329.

    Article  PubMed  Google Scholar 

  8. Klotz L . Active surveillance: the Canadian experience with an ‘inclusive approach’. J Natl Cancer Inst Monogr 2012; 45: 234–241.

    Article  Google Scholar 

  9. Thaxton CS, Loeb S, Roehl KA, Kan D, Catalona WJ . Treatment outcomes of radical prostatectomy in potential candidates for 3 published active surveillance protocols. Urology 2010; 75: 414–418.

    Article  PubMed  Google Scholar 

  10. Van den Bergh RC, Roemeling S, Roobol MJ, Aus G, Hugosson J, Rannikko AS et al. Gleason score 7 screen-detected prostate cancers initially managed expectantly: outcomes in 50 men. BJU Int 2009; 103: 1472–1477.

    Article  PubMed  Google Scholar 

  11. Ploussard G, Isbarn H, Briganti A, Sooriakumaran P, Surcel CI, Salomon L et al. Can we expand active surveillance criteria to include biopsy Gleason 3+4 prostate cancer? A multi-institutional study of 2323 patients. Urol Oncol 2014; 33: 71.e1–9.

    Article  Google Scholar 

  12. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds). AJCC Cancer Staging Manual. 7th edn. Springer: New York, NY, USA, 2010.

    Google Scholar 

  13. Cooperberg MR, Cowan JE, Hilton JF, Reese AC, Zaid HB, Porten SP et al. Outcomes of active surveillance for men with intermediate-risk prostate cancer. J Clin Oncol 2011; 29: 228–234.

    Article  PubMed  Google Scholar 

  14. Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 2015; 33: 272–277.

    Article  PubMed  Google Scholar 

  15. Hardie C, Parker C, Norman A, Eeles R, Horwich A, Huddart R et al. Early outcomes of active surveillance for localized prostate cancer. BJU Int 2005; 95: 956–960.

    Article  PubMed  Google Scholar 

  16. Huang CC, Kong MX, Zhou M, Rosenkrantz AB, Taneja SS, Melamed J et al. Gleason score 3+4=7 prostate cancer with minimal quantity of Gleason pattern 4 on needle biopsy is associated with low-risk tumor in radical prostatectomy specimen. Am J Surg Pathol 2014; 38: 1096–1101.

    Article  PubMed  Google Scholar 

  17. Chen DJ, Falzarano SM, McKenney JK, Przybycin CG, Reynolds JP, Roma A et al. Does cumulative prostate cancer length in prostate biopsies improve prediction of clinically insignificant cancer at radical prostatectomy in patients eligible for active surveillance? BJU Int 2014, (doi:10.1111/bju.12880).

    Article  PubMed  Google Scholar 

  18. Russo GI, Cimino S, Castelli T, Favilla V, Urzì D, Veroux M et al. Percentage of cancer involvement in positive cores can predict unfavorable disease in men with low-risk prostate cancer but eligible for the prostate cancer international: Active surveillance criteria. Urol Oncol 2014; 32: 291–296.

    Article  PubMed  Google Scholar 

  19. Komai Y, Kawakami S, Numao N, Fujii Y, Saito K, Kubo Y et al. Extended biopsy based criteria incorporating cumulative cancer length for predicting clinically insignificant prostate cancer. BJU Int 2012; 110: E564–E569.

    Article  CAS  PubMed  Google Scholar 

  20. Gondo T, Hricak H, Sala E, Zheng J, Moskowitz CS, Bernstein M et al. Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients?with biopsy-proven Gleason score 3+4 prostate cancer. Eur Radiol 2014; 24: 3161–3170.

    Article  PubMed  Google Scholar 

  21. Bertaccini A, Franceschelli A, Schiavina R, Marchiori D, Baccos A, Pernetti R et al. Accuracy of a new echographic method (RULES, radiofrequency ultrasonic local estimators) in prostate cancer diagnosis. Anticancer Res 2008; 28: 1883–1886.

    PubMed  Google Scholar 

  22. Testa C, Schiavina R, Lodi R, Salizzoni E, Tonon C, D’Errico A et al. Accuracy of MRI/MRSI-based transrectal ultrasound biopsy in peripheral and transition zones of the prostate gland in patients with prior negative biopsy. NMR Biomed 2010; 23: 1017–1026.

    Article  CAS  PubMed  Google Scholar 

  23. Epstein JI, Herawi M . Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J Urol 2006; 175: 820–834.

    Article  PubMed  Google Scholar 

  24. Raskolnikov D, Rais-Bahrami S, George AK, Turkbey B, Shakir NA, Okoro C et al. The role of image-guided biopsy targeting in patients with atypical small acinar proliferation. J Urol 2014; 193: 473–478.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Brausi M, Castagnetti G, Dotti A, De Luca G, Olmi R, Cesinaro AM . Immediate radical prostatectomy in patients with atypical small acinar proliferation. Over treatment? J Urol 2004; 172: 906–908.

    Article  PubMed  Google Scholar 

  26. Wolters T, Roobol MJ, van Leeuwen PJ, van den Bergh RC, Hoedemaeker RF, van Leenders GJ et al. A critical analysis of the tumor volume threshold for clinically insignificant prostate cancer using a data set of a randomized screening trial. J Urol 2011; 185: 121–125.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    R Schiavina, M Borghesi, E Brunocilla, D Romagnoli, D Diazzi, V Vagnoni, C V Pultrone, H Dababneh & G Martorana

  2. Postgraduate Speciality School of Specialization in Urology, University of Bologna, Bologna, Italy

    R Schiavina, E Brunocilla & G Martorana

  3. Department of Specialistic, Diagnostic and Experimental Medicine, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    R Schiavina, E Brunocilla & G Martorana

  4. Doctorate in Cardiologic, Nephro-Urologic and Thoracic Science, University of Bologna, Bologna, Italy

    M Borghesi & C V Pultrone

  5. Pathology Service, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    F Giunchi & M Fiorentino

  6. Department of Urology, Policlinico Abano Terme, Padua, Italy

    A Porreca

Authors
  1. R Schiavina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Borghesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E Brunocilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Romagnoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D Diazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F Giunchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V Vagnoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C V Pultrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H Dababneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A Porreca
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M Fiorentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. G Martorana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R Schiavina.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schiavina, R., Borghesi, M., Brunocilla, E. et al. The biopsy Gleason score 3+4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3+3: looking for larger selection criteria for active surveillance candidates. Prostate Cancer Prostatic Dis 18, 270–275 (2015). https://doi.org/10.1038/pcan.2015.21

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2015.21

  • Springer Nature Limited

This article is cited by

Search

Navigation