Prostate cancer outcomes of men with biopsy Gleason score 6 and 7 without cribriform or intraductal carcinoma

Publication date: October 2016
Source:European Journal of Cancer, Volume 66
Author(s): Charlotte F. Kweldam, Intan P. Kümmerlin, Daan Nieboer, Esther I. Verhoef, Ewout W. Steyerberg, Luca Incrocci, Chris H. Bangma, Theodorus H. van der Kwast, Monique J. Roobol, Geert J. van Leenders
Aim of the studyGleason score (GS) 3 + 4 = 7 prostate cancer patients with presence of cribriform or intraductal carcinoma (7⁺) have a worse disease-specific survival than those without. The aim of this study was to compare the clinicopathologic characteristics and patient outcomes of men with biopsy GS 3 + 4 = 7 without cribriform or intraductal carcinoma (7^–) to those with GS 3 + 3 = 6.Materials and methodsWe included all patients from the first screening round of the European Randomized Study of Screening for Prostate Cancer (1993–2000) with a revised GS ≤ 3 + 4 = 7 (n = 796) following the 2014 International Society of Urological Pathology criteria. Relations with biochemical recurrence after radical prostatectomy or radiotherapy were analysed using log-rank testing and multivariable Cox regression analysis.ResultsIn total, 486 patients had GS 6 and 310 had GS 7, 54 of whom had GS 7⁺ (17%). During a median follow-up of 15 years, biochemical recurrence was seen in 61 (20%) GS 6, 54 (21%) GS 7^– and 22 (41%) GS 7⁺ patients (41%). Both biopsy GS 7^– and 7⁺ patients had significantly higher prostate-specific antigen levels, mean tumour percentage, percentage of positive cores and ≥cT3 than those with GS 6 (all P < .001). GS 7^– patients did not have a poorer biochemical recurrence-free survival (BCRFS) after radical prostatectomy than GS 6 patients (log-rank P = .13), whereas those with GS 7⁺ had (log-rank P = .05). In multivariable analyses, biopsy GS 7^– was not associated with poorer BCRFS after radical prostatectomy (hazard ratio [HR], 1.3; 95% confidence interval [CI]: 0.67–2.4; P = .47) or radiotherapy (HR, 0.88; 95% CI: 0.51–1.5; P = .63). GS 7⁺ was independently associated with poorer BCRFS after radical prostatectomy (HR, 3.0; 95% CI: 1.1–7.8; P = .03), but not after radiotherapy (HR, 1.2; 95% CI: 0.58–2.3; P = .67).ConclusionsMen with biopsy GS 7^– prostate cancer have similar BCRFS after radical prostatectomy or radiotherapy to those with GS 6 and may be candidates for active surveillance as long as other inclusion criteria such as on PSA and tumour volume are met.



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