Quantification of Gleason Pattern 4 Metrics Identifies Pathologic Progression in Patients With Grade Group 2 Prostate Cancer on Active Surveillance

•During active surveillance (AS) for Grade Group (GG) 2 prostate cancer, pathologic progression to GG3 on surveillance biopsy is a trigger for intervention.•The ratio of GP3:GP4, may be obscured by increases of relatively indolent disease and therefore quantification of GP4 remains ill defined.•We f...

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Published in:Clinical genitourinary cancer 2024-12, Vol.22 (6), p.102204, Article 102204
Main Authors: Perera, Marlon, Assel, Melissa, Nalavenkata, Sunny, Khaleel, Sari, Benfante, Nicole, Carlsson, Sigrid V., Reuter, Victor E., Laudone, Vincent P., Scardino, Peter T., Touijer, Karim A., Eastham, James A., Vickers, Andrew J., Fine, Samson W., Ehdaie, Behfar
Format: Article
Language:English
Subjects:
Biomarker
ISUP grading
Outcomes
Prostate biopsy
Risk stratfication
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Summary:•During active surveillance (AS) for Grade Group (GG) 2 prostate cancer, pathologic progression to GG3 on surveillance biopsy is a trigger for intervention.•The ratio of GP3:GP4, may be obscured by increases of relatively indolent disease and therefore quantification of GP4 remains ill defined.•We found large increases in GP4 length (mm) do not always meet criteria for diagnosis of GG3 disease whilst upgrading to GG3 can occur despite a minimal change in length of GP4 (mm).•Our results suggest that length of GP4, in addition to reclassification to GG3 disease, should be considered in assessing disease progression or reclassification in men with GG2 disease on AS. During active surveillance (AS) for Grade Group (GG) 2 prostate cancer, pathologic progression to GG3 on surveillance biopsy is a trigger for intervention. However, this ratio of GP3:GP4, may be obscured by increases of relatively indolent disease. We aimed to explore changes in GP4 quantity during AS and propose alternative definitions for progression based on GP4 changes. We assessed patients enrolled on AS between November 2014 and March 2020 with GG2 disease on diagnostic biopsy and subsequent surveillance biopsy approximately 1 year later. Outcome measures included change in overall %GP4 and total length GP4 (mm). 61 patients met the inclusion criteria, the median change in total length of GP4 and %GP4 was -0.12 mm (IQR −0.31, 0.09) and −2.5% (IQR −8.6, 0.0), respectively. Excluding the 35 patients with no evidence of GP4 on surveillance biopsy, median change in total GP4 length and %GP4 was 0.19 mm (IQR −0.04, 0.67) and 1.2% (IQR −1.6, 6.6), respectively. Three patients progressed to GG3 disease on surveillance biopsy, one of whom had only a small increase in %GP4. Conversely, an additional 2 patients who did not meet the criterion for GG3 had a large increase (> 1 mm) in total GP4 length. Presence of GG3 disease on surveillance biopsy as a trigger for treatment in men on AS is of questionable use alone; we suggest including other measures that do not depend on a ratio, such as an increase in total GP4 length. Pathological progression to Grade Group 3 (GG3) disease in active surveillance prompts intervention, but the optimal method for Gleason pattern 4 (GP4) quantification remains unclear. Significant increases in GP4 length do not always meet GG3 criteria, while upgrading to GG3 can happen with minimal changes in GP4 length. We present an alternative method for grading GP4 is presented, hi
ISSN:1558-7673
1938-0682
1938-0682
DOI:10.1016/j.clgc.2024.102204