EURURO Vol. 71 No. 5

Platinum Priority – Prostate Cancer

Application of a Prognostic Gleason Grade Grouping System to

Assess Distant Prostate Cancer Outcomes

Michael S. Leapman

a , b , * ,

Janet E. Cowan

a ,

Jeffry Simko

a , c ,

Gray Roberge

a ,

Bradley A. Stohr

c ,

Peter R. Carroll

a ,

Matthew R. Cooperberg

a , d

Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA;

Department of

Urology, Yale University School of Medicine, New Haven, CT, USA;

Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of

California San Francisco, San Francisco, CA, USA;

Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center,

University of California San Francisco, San Francisco, CA, USA

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 5 0 – 7 5 9

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted November 24, 2016

Associate Editor:

James Catto

Keywords:

Prognostic Gleason score

Prostate cancer

Prostate cancer–specific

mortality

Abstract

Background:

There is growing enthusiasm for the adoption of a novel grade grouping

system to better represent Gleason scores.

Objective:

To evaluate the ability of prognostic Gleason grade groups to predict prostate

cancer (PCa)–specific mortality (PCSM) and bone metastatic progression.

Design, setting, and participants:

We identified patients with PCa enrolled in the Cancer

of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry across treat-

ment strategies, including conservative and nondefinitive therapy.

Outcome measurements and statistical analysis:

We examined the prognostic ability of

Gleason grade groups to predict risk of PCSM and bone metastasis using the Kaplan-

Meier method and unadjusted and adjusted Cox proportional hazards models.

Results and limitations:

We identified 10 529 men with PCa followed for a median of

81 mo (interquartile range 40–127), including 64% in group I (

3 + 4); 17% in group II

(3+4); 9% in group III (4+3); 6% in group IV (4+4); and 4% in group V ( 4 + 5). Relative to

grade group I, the unadjusted risks of PCSM and bone metastasis were significantly

associated with prognostic grade groupings for both biopsy and prostatectomy samples

(all

0.01). Pairwise comparisons within Gleason sums collapsed within grade group

V were not significant; however, this analysis was limited by a small representation of

men with Gleason pattern 4 + 5.

Conclusions:

The prognostic grade grouping system is associated with risk of PCSM and

metastasis across management strategies, including definitive therapy, conservative

management, and primary androgen deprivation.

Patient summary:

A five-level reporting system for prostate cancer pathology is asso-

ciated with the risk of late prostate cancer endpoints.

* Corresponding author. Department of Urology, Yale University School of Medicine, 789 Howard

Avenue, Box 208058, Fitkin 300, New Haven, CT, USA. Tel. +1 203 7853128; Fax: +1 203 7854043.

E-mail address:

michael.leapman@yale.edu

(M.S. Leapman).

http://dx.doi.org/10.1016/j.eururo.2016.11.032

0302-2838/