Skip to main content

Advertisement

SpringerLink
Log in

Characteristics of modern Gleason 9/10 prostate adenocarcinoma: a single tertiary centre experience within the Republic of Ireland

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

An Erratum to this article was published on 15 February 2014

Abstract

Introduction

The 2005 international society of urological pathology consensus statement on Gleason grading in prostate cancer revised Gleason scoring in clinical practice. The potential for grade migration with this refinement poses difficulties in interpreting historical series. We report the characteristics of a recent cohort of consecutive Gleason score 9 or 10 prostate cancers in our institution. The purpose of this study was to define the clinicopathologic variables and staging information for this high-risk population, and to identify whether traditional prostate staging techniques are adequate for this subcohort of men.

Materials and methods

A computational review of our pathology database was performed. Between May 2010 and September 2012, 1,295 consecutive biopsies were undertaken, 168 of which were high-grade tumours (12.97 %). This group were divided into two cohorts of which 84 (12.05 %) had a highest reported Gleason score of 9 (N = 79) or 10 (N = 5) and 84 were reported as Gleason 8. All biopsies were double-reported by pathologists with a special interest in uropathology.

Results

Men diagnosed with a Gleason pattern 5 tumour were statistically far more likely to have advanced disease on direct rectal examination of the prostate compared with Gleason sum 8 tumours (p < 0.001) and a positive first-degree family history of prostate cancer (p < 0.001). Overall, Gleason sum 9/10 prostate cancers were also found to be statistically more aggressive than Gleason sum 8 tumours on TRUS core biopsy analysis with significantly higher levels of perineural invasion (p < 0.0001) and extracapsular extension (p = 0.001) as well as a higher levels of tumour found within the core biopsy sample. Those men diagnosed with Gleason pattern 5 prostate cancer also had radiological indicators of increased tumour aggressiveness compared with Gleason sum 8 cancer with respect to bone (p = 0.0002) and visceral (p = 0.044) metastases at presentation.

Conclusions

This series of Gleason score 9/10 prostate cancers serves to highlight the large disease burden, adverse pathologic features, and locally advanced nature of this aggressive subtype, which has previously been under-described in the literature, and differs from historical series in having a large high-grade cohort demonstrating high rates of metastatic disease. A history of prostate cancer amongst first-degree relatives was particularly prevalent in this population raising the issue of screening in a high-risk population. The high incidence of visceral metastatic disease at presentation supports upfront staging with CT thorax, abdomen, and pelvis in patients with Gleason 9 or 10 prostate cancers.

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

Fig. 1

Similar content being viewed by others

Abbreviations

CaP:

Prostate cancer

CT:

Computed tomography

EBRT:

External beam radiation therapy

GP:

General practitioner

ISUP:

International society for urological pathology

MRI:

Magnetic resonance imaging

PSA:

Prostate-specific antigen

TNM:

Tumour, node, metastasis

TRUS:

Transrectal ultrasound

References

  1. http://www.ncri.ie/pubs/pubfiles/AnnualReport2011.pdf

  2. Epstein JI (2010) An update of the Gleason grading system. J Urol 183:443

    Google Scholar 

  3. Nanda A, Chen MH, Renshaw AA et al (2009) Gleason pattern 5 prostate cancer: further stratification of patients with high-risk disease and implications for future randomized trials. Int J Radiat Oncol Biol Phy 74:1419

    Article  Google Scholar 

  4. Pierorazio PM, Guzzo TJ, Han M et al (2010) Long-term survival after radical prostatectomy for men with high Gleason sum in pathologic specimen. Urology 76:715

    Article  PubMed Central  PubMed  Google Scholar 

  5. Chan SM, Garcia FJ, Chin JL et al (2011) The clinical significance of in-depth pathological assessment of extraprostatic extension and margin status in radical prostatectomies for prostate cancer. Prostate Cancer Prostatic Dis 14(4):307–312

    Article  CAS  PubMed  Google Scholar 

  6. Sebo TJ, Bock BJ, Cheville JC et al (2000) The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol 163:174–178

    Article  CAS  PubMed  Google Scholar 

  7. D’Amico AV, Whittington R, Malkowicz SB et al (2000) Clinical utility of the percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer. J Clin Oncol 18:1164–1172

    PubMed  Google Scholar 

  8. Freedland SJ, Aronson WJ, Terris MK et al (2003) Percent of prostate needle biopsy cores with cancer is significant independent predictor of prostate specific antigen recurrence following radical prostatectomy: results from SEARCH database. J Urol 169:2136–2141

    Article  PubMed  Google Scholar 

  9. Chaux A, Fajardo DA, Gonzalez-Roibon N et al (2012) High grade prostatic adenocarcinoma present in a single biopsy core is associated with increased extraprostatic extension, seminal vesicle invasion, and positive surgical margins at prostatectomy. Urology 79(4):863–868

    Article  PubMed Central  PubMed  Google Scholar 

  10. Eifler JB, Feng Z, Lin BM et al (2012) An updated prostate cancer staging nomogram (Partin Tables) based on cases from 2006–2011. BJU Int 111:22–29

    Article  PubMed  Google Scholar 

  11. Epstein JI, Allsbrook WC Jr, Amin MB et al (2005) The 2005 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29:1228–1242

    Article  PubMed  Google Scholar 

  12. Uemura H, Hoshino K, Sasaki T et al (2009) Usefulness of the 2005 International Society of Urologic Pathology Gleason grading system in prostate biopsy and radical prostatectomy specimens. BJU Int 103:1190–1194

    Article  PubMed  Google Scholar 

  13. Stark JR, Perner S, Stampfer MJ et al (2009) Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3? J Clin Oncol 27:3459–3464

    Article  PubMed Central  PubMed  Google Scholar 

  14. Stenmark MH, Blas K, Halverson S et al (2011) Continued benefit to androgen deprivation therapy for prostate cancer patients treated with dose-escalated radiation therapy across multiple definitions of high-risk disease. Int J Radiat Oncol Biol Phys 81:e335–e344

    Article  PubMed  Google Scholar 

  15. Patel AA, Chen MH, Renshaw AA, D’Amico AV (2007) PSA failure following definitive treatment of prostate cancer having biopsy Gleason score 7 with tertiary grade 5. JAMA 298:1533–1538

    CAS  PubMed  Google Scholar 

  16. Sabolch A, Feng FY, Daignault-Newton S et al (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:e351–e360

    Article  PubMed  Google Scholar 

  17. Eifler JB, Feng Z, Lin BM et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. (in press). doi:10.1111/j.1464-410X.2012.11324.x

  18. Epstein JI, Feng Z, Trock BJ et al (2012) Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol 61(5):1019–1024

    Article  PubMed  Google Scholar 

  19. Moussa AS, Li J, Soriano M et al (2009) Prostate biopsy and clinical and pathological variables that predict significant grading changes in patients with intermediate and high grade prostate cancer. BJU Int 103(1):43–48

    Article  PubMed  Google Scholar 

  20. DeLancey JO, Wood DP Jr, He C et al (2013) Evidence of perineural invasion on prostate biopsy specimen and survival after radical prostatectomy. Urology 81(2):354–357

    Article  PubMed  Google Scholar 

  21. Feng FY, Qian Y, Stenmark MH et al (2011) Perineural invasion predicts increased recurrence, metastasis and death from prostate cancer following treatment with dose-escalated radiation therapy. Int J Radiat Oncol Biol Phys 81(4):e361–e367

    Article  PubMed  Google Scholar 

  22. Nanda A, Chen MH, Renshaw AA et al (2009) Gleason pattern 5 prostate cancer: further stratification of patients with high-risk disease and implications for future randomized trials. Int J Radiat Oncol Biol Phys 74(5):1419–1423

    Article  PubMed  Google Scholar 

  23. Moreira DM, Banez LL, Presti JC et al (2010) Predictors of secondary treatment following biochemical recurrence after radical prostatectomy: results from the shared equal access regional cancer hospital database. BJU Int 105(1):28–33

    Article  PubMed  Google Scholar 

  24. Elshafei A, Moussa AS, Hatem A et al (2013) Does positive family history of prostate cancer increase the risk of prostate cancer on initial prostate biopsy. Urology 81(4):826–830

    Article  PubMed  Google Scholar 

  25. Roudgari H, Hemminki K, Brandt A et al (2012) Prostate cancer risk assessment model: a scoring model based on the Swedish family-cancer database. J Med Genet 49(5):345–352

    Article  CAS  PubMed  Google Scholar 

  26. Jansson KF, Akre O, Garmo H et al (2012) Concordance of tumour differentiation among brothers with prostate cancer. Eur Urol 62(4):656–661

    Article  PubMed  Google Scholar 

  27. Cancer Research UK (2011) European age-standardized rates of prostate cancer. GLOBOCAN 2008 v1.2. IARC. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/uk-prostate-cancer-incidence-statistics

  28. Holmstrom B, Holmberg E, Egevad L, Adolfsson J, Johansson JE, Stattin P, National Prostate Cancer Registry of Sweden (2010) Outcome of primary versus deferred radical prostatectomy in the National Prostate Cancer Register of Sweden Follow-Up Study. J Urol 184:1322–1327

    Article  PubMed  Google Scholar 

  29. O’Brien D, Loeb S, Carvalhal GF et al (2011) Delay of surgery in men with low risk prostate cancer. J Urol 185:2143–2147

    Article  PubMed  Google Scholar 

  30. Lee N, Newhouse JH, Olsson CA et al (1999) Which patients with newly diagnosed prostate cancer need a computed tomography scan of the abdomen and pelvis? An analysis based on 588 patients. Urology 54(3):490–494

    Article  CAS  PubMed  Google Scholar 

  31. Masterson TA, Touijer K (2008) The role of endorectal coil MRI in preoperative staging and decision-making for the treatment of clinically localized prostate cancer. MAGMA 21(6):371–377

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Cork/Mercy University Hospitals, Cork, Ireland

    F. O’Kelly, S. Elamin, A. Cahill, P. Aherne, M. F. O’Brien & P. Sweeney

  2. Department of Radiology, Cork/Mercy University Hospitals, Cork, Ireland

    J. Buckley, K. N. O’Regan & A. Brady

  3. Department of Pathology, Cork/Mercy University Hospitals, Cork, Ireland

    J. White & N. Mayer

  4. Department of Medical Oncology, Cork/Mercy University Hospitals, Cork, Ireland

    D. G. Power

  5. Department of Radiation Oncology, Cork/Mercy University Hospitals, Cork, Ireland

    P. J. Kelly

Authors
  1. F. O’Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Elamin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Cahill
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Aherne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Buckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. N. O’Regan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Brady
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. G. Power
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. F. O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P. Sweeney
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. N. Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. P. J. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. O’Kelly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

O’Kelly, F., Elamin, S., Cahill, A. et al. Characteristics of modern Gleason 9/10 prostate adenocarcinoma: a single tertiary centre experience within the Republic of Ireland. World J Urol 32, 1067–1074 (2014). https://doi.org/10.1007/s00345-013-1184-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-013-1184-2

Keywords

Search

Navigation