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Pathology & Oncology Research

, Volume 24, Issue 4, pp 921–925 | Cite as

ISUP Group 4 – a Homogenous Group of Prostate Cancers?

  • Thomas Chengxuan Lu
  • Kim Moretti
  • Kerri Beckmann
  • Penelope Cohen
  • Michael O’Callaghan
Short Communication
  • 120 Downloads

Abstract

The International Society of Urological Pathology (ISUP) and the World Health Organisation have adopted a five-tiered prognostic grade group for prostate cancer in 2014. Grade group 4 is comprised of Gleason patterns 4 + 4, 3 + 5 and 5 + 3. Recent articles have suggested heterogeneity in their prognostic outcomes. We aimed to determine whether there was a difference in mortality outcomes within the ISUP 4 grouping, as identified on needle biopsy. A total of 4080 men who were diagnosed with non-metastatic (N0 M0) prostate cancer on biopsy with Gleason scores of 7, 8 and 9 were included. Multi-variable Cox Regression and Fine and Grey competing risk analysis were used to determine the All-Cause Mortality (ACM) and the Prostate Cancer Specific Mortality (PCSM) as a function of Gleason Scores (Gleason 3 + 4, 4 + 3, 4 + 4, 3 + 5/5 + 3, 9). Gleason score 4 + 4 was utilized as the referent. The 60 months’ prostate cancer specific mortality with Gleason patterns 4 + 4 and 3 + 5/5 + 3 were 17% and 20% respectively (P < 0.01). Patients with 3 + 5/5 + 3 disease, had no statistically significant difference in the ACM (adjusted hazard ratio [aHR] 0.99, 95% confidence interval [Cl] 0.68–1.4, p = 0.99) and PCSM risk (aHR 0.77, 95% Cl 0.47–1.2, p = 0.31) when compare with the referent group of patients. Patients with Gleason patterns 4 + 3 and 9 had statistically significant difference in their PCSM risk (aHR 0.70, 95% CI 0.54–0.91, P < 0.001 and aHR 1.5, 95% Cl 1.2–1.9, P < 0.001) when compared to the referent group. Our analysis suggest that ISUP group 4 is homogenous in terms of the all-cause mortality and the prostate cancer specific morality risk as differentiated by the presence of Gleason 5 score.

Keywords

Prostate cancer Gleason score Grade group 4 Biopsy Prostate cancer specific mortality 

Notes

Acknowledgements

Thomas Lu is a University of Adelaide summer research scholar. Bursary was partially funded by the Freemasons Foundation Centre of Men’s Health.

Compliance with Ethical Standards

Conflict of Interest

Nil

Ethical Approval

All data utilised in the study was attained from the South Australian Prostate Cancer Clinical Outcomes Collaboration. Ethical approval is provided for analyses using de-identified data, a condition which this study met.

Informed Consent

The South Australian Prostate Cancer Clinical Outcomes Collaboration database operates under an ethically approved opt-out consent model.

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Copyright information

© Arányi Lajos Foundation 2017

Authors and Affiliations

  • Thomas Chengxuan Lu
    • 1
    • 2
  • Kim Moretti
    • 3
    • 4
    • 5
    • 6
    • 7
  • Kerri Beckmann
    • 4
    • 5
  • Penelope Cohen
    • 8
  • Michael O’Callaghan
    • 4
    • 9
    • 10
    • 11
  1. 1.University of AdelaideAdelaideAustralia
  2. 2.Royal Adelaide HospitalAdelaideAustralia
  3. 3.Queen Elisabeth Hospital, Repatriation HospitalWoodvilleAustralia
  4. 4.South Australia Prostate Cancer Clinical Outcomes Collaboration, Repatriation HospitalAdelaideAustralia
  5. 5.University of South Australia, School of Population HealthAdelaideAustralia
  6. 6.University of Adelaide, Discipline of SurgeryAdelaideAustralia
  7. 7.Flinders University, Discipline of SurgeryAdelaideAustralia
  8. 8.SA Pathology, Royal Adelaide HospitalAdelaideAustralia
  9. 9.Urology UnitRepatriation General HospitalAdelaideAustralia
  10. 10.Flinders Centre for Innovation in CancerAdelaideAustralia
  11. 11.University of Adelaide, Freemasons Centre for Men’s Health, Discipline of MedicineAdelaideAustralia

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