Advertisement

Prognostic Differences in ISUP Grade Group 4: a Systematic Review and Meta-Analysis

  • Thomas Chengxuan LuEmail author
  • Luke Collins
  • Penelope Cohen
  • Alex Jay
  • Jared M. Campbell
  • Michael O’Callaghan
Review

Abstract

The ISUP (Internal Society of Urologic Pathology) recently adopted a five-tiered prognostication system. There is evidence to suggest that the ISUP grade group 4 is a heterogeneous entity regarding prognosis. Our aim was to systematically examine the existing evidence to determine if outcome differences exist within the ISUP grade group 4. A systematic search of the literature for all studies examining the heterogeneity of the ISUP grade group 4 was conducted. Available studies were combined with meta-analysis to evaluate prognostic differences within the ISUP grade group 4 measured by all-cause mortality (ACM) and the prostate cancer-specific mortality (PCSM). Eight studies were identified and utilised a variety of outcome measures to answer the question of heterogeneity within the ISUP grade group 4. Four of these studies examined prognosis using both ACM and PCSM. These were combined into a meta-analysis. The combined group of 5 + 3/3 + 5 had statistically significant higher ACM (hazard ratio [HR] 1.23, 95% confidence internal [Cl] 1.08–1.41) when compared to the 4 + 4 group. There was no difference in the PCSM between the two groups (HR 1.34, 95% CI 0.89–2.01). However, heterogeneity was high for this analysis secondary to a range of methodological differences. Our meta-analysis showed that Gleason grade 3 + 5/5 + 3 had higher ACM than Gleason grade group 4 + 4. Measures of PCSM were statistically insignificant, although heterogeneity was high. Evidence suggests that heterogeneity is likely, although inconclusive. Further studies with consistent methodologies are required to answer this question.

Keywords

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

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there is no conflict of interests in this work.

References

  1. 1.
    Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, Freedland SJ, Greene K, Klotz LH, Makarov DV, Nelson JB, Rodrigues G, Sandler HM, Taplin ME, Treadwell JR (2017) Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol 199:683–690.  https://doi.org/10.1016/j.juro.2017.11.095 CrossRefGoogle Scholar
  2. 2.
    Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, Freedland SJ, Greene K, Klotz LH, Makarov DV, Nelson JB, Rodrigues G, Sandler HM, Taplin ME, Treadwell JR (2018) Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part II: recommended approaches and details of specific care options. J Urol 199(4):990–997.  https://doi.org/10.1016/j.juro.2018.01.002 CrossRefGoogle Scholar
  3. 3.
    Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29(9):1228–1242CrossRefGoogle Scholar
  4. 4.
    (NCCN) NCCN (2018) Clinical practice guidelines on prostate cancerGoogle Scholar
  5. 5.
    Epstein JI, Zelefsky MJ, Sjoberg DD, Nelson JB, Egevad L, Magi-Galluzzi C, Vickers AJ, Parwani AV, Reuter VE, Fine SW, Eastham JA, Wiklund P, Han M, Reddy CA, Ciezki JP, Nyberg T, Klein EA (2016) A contemporary prostate Cancer grading system: a validated alternative to the Gleason score. Eur Urol 69(3):428–435.  https://doi.org/10.1016/j.eururo.2015.06.046 CrossRefGoogle Scholar
  6. 6.
    Burdick MJ, Reddy CA, Ulchaker J, Angermeier K, Altman A, Chehade N, Mahadevan A, Kupelian PA, Klein EA, Ciezki JP (2009) Comparison of biochemical relapse-free survival between primary Gleason score 3 and primary Gleason score 4 for biopsy Gleason score 7 prostate cancer. Int J Radiat Oncol Biol Phys 73(5):1439–1445.  https://doi.org/10.1016/j.ijrobp.2008.07.033 CrossRefGoogle Scholar
  7. 7.
    Kang DE, Fitzsimons NJ, Presti JC Jr, Kane CJ, Terris MK, Aronson WJ, Amling CL, Freedland SJ, Group SDS (2007) Risk stratification of men with Gleason score 7 to 10 tumors by primary and secondary Gleason score: results from the SEARCH database. Urology 70(2):277–282.  https://doi.org/10.1016/j.urology.2007.03.059 CrossRefGoogle Scholar
  8. 8.
    Koontz BF, Tsivian M, Mouraviev V, Sun L, Vujaskovic Z, Moul J, Lee WR (2012) Impact of primary Gleason grade on risk stratification for Gleason score 7 prostate cancers. Int J Radiat Oncol Biol Phys 82(1):200–203.  https://doi.org/10.1016/j.ijrobp.2010.11.023 CrossRefGoogle Scholar
  9. 9.
    Stark JR, Perner S, Stampfer MJ, Sinnott JA, Finn S, Eisenstein AS, Ma J, Fiorentino M, Kurth T, Loda M, Giovannucci EL, Rubin MA, Mucci LA (2009) Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3? J Clin Oncol 27(21):3459–3464.  https://doi.org/10.1200/jco.2008.20.4669 CrossRefGoogle Scholar
  10. 10.
    Tollefson MK, Leibovich BC, Slezak JM, Zincke H, Blute ML (2006) Long-term prognostic significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer: impact on prostate cancer specific survival. J Urol 175(2):547–551.  https://doi.org/10.1016/s0022-5347(05)00152-7 CrossRefGoogle Scholar
  11. 11.
    Wright JL, Salinas CA, Lin DW, Kolb S, Koopmeiners J, Feng Z, Stanford JL (2009) Prostate cancer specific mortality and Gleason 7 disease differences in prostate cancer outcomes between cases with Gleason 4 + 3 and Gleason 3 + 4 tumors in a population based cohort. J Urol 182(6):2702–2707.  https://doi.org/10.1016/j.juro.2009.08.026 CrossRefGoogle Scholar
  12. 12.
    Huynh MA, Chen MH, Wu J, Braccioforte MH, Moran BJ, D'Amico AV (2016) Gleason score 3 + 5 or 5 + 3 versus 4 + 4 prostate cancer: the risk of death. Eur Urol 69(6):976–979.  https://doi.org/10.1016/j.eururo.2015.08.054 CrossRefGoogle Scholar
  13. 13.
    Mahal BA, Muralidhar V, Chen YW, Choueiri TK, Hoffman KE, Hu JC, Sweeney CJ, Yu JB, Feng FY, Trinh QD, Nguyen PL (2016) Gleason score 5 + 3 = 8 prostate cancer: much more like Gleason score 9? BJU Int 118(1):95–101.  https://doi.org/10.1111/bju.13239 CrossRefGoogle Scholar
  14. 14.
    Thomas Chengxuan Lu MOC (2017) Are there prognostic differences within the International Society of Urological Pathology Grade Group 4 comprised of Gleason pattern 4+4, 3+5, 5+3? A systematic review. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017058923. Accessed 27 May 2017
  15. 15.
    Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605.  https://doi.org/10.1007/s10654-010-9491-z CrossRefGoogle Scholar
  16. 16.
    Lu TC, Moretti K, Beckmann K, Cohen P, O'Callaghan M (2017) ISUP group 4 - a homogenous group of prostate cancers? Pathol Oncol Res 24:921–925.  https://doi.org/10.1007/s12253-017-0331-2 CrossRefGoogle Scholar
  17. 17.
    Rusthoven CG, Carlson JA, Waxweiler TV, Yeh N, Raben D, Flaig TW, Kavanagh BD (2014) The prognostic significance of Gleason scores in metastatic prostate cancer. Urol Oncol 32(5):707–713.  https://doi.org/10.1016/j.urolonc.2014.01.004 CrossRefGoogle Scholar
  18. 18.
    Rusthoven CG, Waxweiler TV, DeWitt PE, Flaig TW, Raben D, Kavanagh BD (2015) Gleason stratifications prognostic for survival in men receiving definitive external beam radiation therapy for localized prostate cancer. Urol Oncol 33(2):71 e11–71 e79.  https://doi.org/10.1016/j.urolonc.2014.07.010 CrossRefGoogle Scholar
  19. 19.
    Harding-Jackson N, Kryvenko ON, Whittington EE, Eastwood DC, Tjionas GA, Jorda M, Iczkowski KA (2016) Outcome of Gleason 3 + 5 = 8 prostate cancer diagnosed on needle biopsy: prognostic comparison with Gleason 4 + 4 = 8. J Urol 196(4):1076–1081.  https://doi.org/10.1016/j.juro.2016.05.105 CrossRefGoogle Scholar
  20. 20.
    Gandaglia G, Karnes RJ, Sivaraman A, Moschini M, Fossati N, Zaffuto E, Dell'Oglio P, Cathelineau X, Montorsi F, Sanchez-Salas R, Briganti A (2017) Are all grade group 4 prostate cancers created equal? Implications for the applicability of the novel grade grouping. Urol Oncol 35(7):461 e467–461 e414.  https://doi.org/10.1016/j.urolonc.2017.02.012 CrossRefGoogle Scholar
  21. 21.
    van den Bergh RC, van der Kwast TH, de Jong J, Zargar H, Ryan AJ, Costello AJ, Murphy DG, van der Poel HG (2016) Validation of the novel International Society of Urological Pathology 2014 five-tier Gleason grade grouping: biochemical recurrence rates for 3+5 disease may be overestimated. BJU Int 118(4):502–505.  https://doi.org/10.1111/bju.13478 CrossRefGoogle Scholar
  22. 22.
    Jackson W, Hamstra DA, Johnson S, Zhou J, Foster B, Foster C, Li D, Song Y, Palapattu GS, Kunju LP, Mehra R, Feng FY (2013) Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer-specific death in patients receiving salvage radiation therapy following radical prostatectomy. Cancer 119(18):3287–3294.  https://doi.org/10.1002/cncr.28215 CrossRefGoogle Scholar
  23. 23.
    Sabolch A, Feng FY, Daignault-Newton S, Halverson S, Blas K, Phelps L, Olson KB, Sandler HM, Hamstra DA (2011) Gleason pattern 5 is the greatest risk factor for clinical failure and death from prostate cancer after dose-escalated radiation therapy and hormonal ablation. Int J Radiat Oncol Biol Phys 81(4):e351–e360.  https://doi.org/10.1016/j.ijrobp.2011.01.063 CrossRefGoogle Scholar
  24. 24.
    Antonarakis ES, Feng Z, Trock BJ, Humphreys EB, Carducci MA, Partin AW, Walsh PC, Eisenberger MA (2012) The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: long-term follow-up. BJU Int 109(1):32–39.  https://doi.org/10.1111/j.1464-410X.2011.10422.x CrossRefGoogle Scholar
  25. 25.
    Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, Partin AW (2005) Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. Jama 294(4):433–439.  https://doi.org/10.1001/jama.294.4.433 CrossRefGoogle Scholar
  26. 26.
    Punnen S, Cooperberg MR, D'Amico AV, Karakiewicz PI, Moul JW, Scher HI, Schlomm T, Freedland SJ (2013) Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature. Eur Urol 64(6):905–915.  https://doi.org/10.1016/j.eururo.2013.05.025 CrossRefGoogle Scholar

Copyright information

© Arányi Lajos Foundation 2019

Authors and Affiliations

  1. 1.The George Institute for Global HealthUNSWSydneyAustralia
  2. 2.St George HospitalKogarahAustralia
  3. 3.Westmead HospitalWestmeadAustralia
  4. 4.Royal Adelaide HospitalAdelaideAustralia
  5. 5.SA PathologyRoyal Adelaide HospitalAdelaideAustralia
  6. 6.Urology UnitFlinders Medical CentreBedford ParkAustralia
  7. 7.Centre for Nanoscale Biophotonics, Graduate School of Biomedical EngineeringUNSWSydneyAustralia
  8. 8.South Australia Prostate Cancer Clinical Outcomes CollaborationRepatriation HospitalHeidelberg HeightsAustralia
  9. 9.Flinders Centre for Innovation in CancerFlinders UniversityAdelaideAustralia

Personalised recommendations