Prognosis of Gleason Score 9-10 Prostatic Adenocarcinoma in Needle Biopsies: A Nationwide Population-based Study

Lars Egevad; Chiara Micoli; Hemamali Samaratunga; Brett Delahunt; Hans Garmo; Pär Stattin; Martin Eklund

doi:10.1016/j.euo.2023.11.002

Prognosis of Gleason Score 9-10 Prostatic Adenocarcinoma in Needle Biopsies: A Nationwide Population-based Study

Eur Urol Oncol. 2024 Apr;7(2):213-221. doi: 10.1016/j.euo.2023.11.002. Epub 2023 Nov 17.

Authors

Lars Egevad¹, Chiara Micoli², Hemamali Samaratunga³, Brett Delahunt⁴, Hans Garmo⁵, Pär Stattin⁶, Martin Eklund²

Affiliations

¹ Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. Electronic address: lars.egevad@ki.se.
² Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
³ Aquesta Uropathology and University of Queensland, Brisbane, Queensland, Australia.
⁴ Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Malaghan Institute of Medical Research, Wellington, New Zealand.
⁵ Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences Uppsala University, Uppsala, Sweden.
⁶ Department of Surgical Sciences Uppsala University, Uppsala, Sweden.

PMID: 37978024
DOI: 10.1016/j.euo.2023.11.002

Abstract

Background: Since 2014, prostate cancer is reported using five-tier grouping of Gleason scores. Studies have suggested prognostic heterogeneity within the groups.

Objective: We assessed the risk of prostate cancer death for men diagnosed with Gleason scores 4 + 5, 5 + 4, and 5 + 5 on needle biopsy in a population-based cohort.

Design, setting, and participants: We used the data from Prostate Cancer data Base Sweden (PCBaSe) 4.0 for a survival analysis. Among 199 620 men reported to have prostate cancer in 2000-2020, 172 112 were diagnosed on needle biopsy. The primary treatment was classified as androgen deprivation therapy (66%), deferred treatment (5%), radical prostatectomy (7%), or radical radiotherapy (21%).

Outcome measurements and statistical analysis: The risks of death from prostate cancer in men with Gleason score 9-10 at 5 and 10 yr were used as endpoints. Multivariable Cox regression models controlling for socioeconomic factors and primary treatment were used for time-to-event analyses of death from prostate cancer and death from any causes.

Results and limitations: A total of 20 419 (12%) men had a Gleason score of 9-10, including Gleason scores of 4 + 5, 5 + 4, and 5 + 5 in 14 333 (70%), 4223 (21%), and 1863 (9%) men, respectively. The risks of prostate cancer death for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr of follow-up were 0.45 (confidence interval [CI] 0.44-0.46), 0.56 (0.55-0.58), and 0.66 (0.63-0.68), respectively. The risks of death of any cause for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr were 0.73 (CI 0.72-0.74), 0.81 (0.80-0.83), and 0.87 (0.85-0.89), respectively.

Conclusions: We demonstrate in the largest and most complete cohort analyzed to date that collapsing the Gleason scores by grouping results in loss of prognostic information in men with Gleason score 9-10 cancer.

Patient summary: Survival of prostate cancer patients with the highest tumor grades varies depending on grade composition.

Keywords: Gleason grade; Mortality; Needle biopsy; Prostate cancer.

MeSH terms

Adenocarcinoma*
Androgen Antagonists
Biopsy, Needle
Humans
Male
Neoplasm Grading
Prognosis
Prostatic Neoplasms* / pathology

Substances

Androgen Antagonists