Significance of the Percentage of Gleason Pattern 4 at Prostate Biopsy in Predicting Adverse Pathology on Radical Prostatectomy: Application in Active Surveillance.

Jeffrey Ordner, Abdallah Flaifel, Antonio Serrano, Rebecca Graziano, Jonathan Melamed, Fang-Ming Deng

American journal of clinical pathology 2023 Jul 05

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To determine the prognostic significance of the maximum allowable percentage of Gleason pattern 4 (GP4) at prostate biopsy compared with adverse pathology observed at radical prostatectomy (RP) to expand active surveillance eligibility among a cohort with intermediate risk of prostate cancer. A retrospective study of patients with grade group (GG) 1 or 2 prostate cancer on prostate biopsy with subsequent RP was performed at our institution. A Fisher exact test was used to understand the relationship among GP4 subgroups (0%, ≤5%, 6%-10%, and 11%-49%) assigned at biopsy and adverse pathologic findings at RP. Additional analyses comparing the GP4 ≤5% cohort's prebiopsy prostate-specific antigen (PSA) level and GP4 length with adverse pathology at RP were also performed. No statistically significant difference in adverse pathology at RP was observed between the active surveillance-eligible control (GP4 0%) and the GP4 ≤5% subgroup. In total, 68.9% of the GP4 ≤5% cohort showed favorable pathologic outcomes. A separate analysis of the GP4 ≤5% subgroup revealed that neither prebiopsy serum PSA levels nor GP4 length showed statistical correlation with adverse pathology at RP. Active surveillance may be a reasonable option for management of patients in the GP4 ≤5% group until long-term follow-up data become available. © The Author(s) 2023. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Citation

Jeffrey Ordner, Abdallah Flaifel, Antonio Serrano, Rebecca Graziano, Jonathan Melamed, Fang-Ming Deng. Significance of the Percentage of Gleason Pattern 4 at Prostate Biopsy in Predicting Adverse Pathology on Radical Prostatectomy: Application in Active Surveillance. American journal of clinical pathology. 2023 Jul 05;160(1):35-40