Most Gleason 8 Biopsies are Downgraded at Prostatectomy-Does 4 + 4 = 7?
Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved..
PURPOSE: Nonrepresentative biopsy sampling of prostate cancers with a biopsy Gleason score of 8 can adversely influence decisions regarding androgen deprivation in men receiving primary radiation therapy. The frequency of and factors associated with downgrading Gleason 8 biopsies at prostatectomy are not well known.
MATERIALS AND METHODS: We used records from NCDB (National Cancer Database), a hospital based registry in the United States, of 72,556 men with prostate cancer diagnosed from 2010 to 2013, including 5,474 with Gleason 8 biopsies and no other high progression risk criteria according to NCCN (National Comprehensive Cancer Network®) Guidelines®. The prevalence of Gleason 8 downgrading was calculated. Generalized estimating equation multivariable regression models were used to estimate the prevalence ratios and 95% CIs of downgrading by demographic and clinical factors, and evaluate the association of Gleason 8 downgrading with cT (clinical T) to pathological T category up staging.
RESULTS: Of 5,474 Gleason 8 biopsies in men lacking other high progression risk criteria 3,263 (60%) were downgraded, changing the progression risk category from high to intermediate. A higher prevalence of Gleason 8 downgrading was significantly and independently associated with decreasing age, African American race, lower cT category, lower prostate specific antigen quartile and certain combinations of primary and secondary Gleason grades (3 + 5 greater than 4 + 4 greater than 5 + 3). Gleason 8 downgrading in cases of cT less than 3 was independently and significantly associated with a lower prevalence of up staging (prevalence ratio = 0.65, 95% CI 0.61-0.69).
CONCLUSIONS: Downgrading Gleason 8 biopsies is common. Patient evaluation based on Gleason 8 biopsies often results in overestimating progression risk and disease extent, which may lead to overtreatment.
Errataetall: | |
---|---|
Medienart: |
E-Artikel |
Erscheinungsjahr: |
2018 |
---|---|
Erschienen: |
2018 |
Enthalten in: |
Zur Gesamtaufnahme - volume:199 |
---|---|
Enthalten in: |
The Journal of urology - 199(2018), 3 vom: 15. März, Seite 706-712 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Gansler, Ted [VerfasserIn] |
---|
Links: |
---|
Themen: |
Biopsy |
---|
Anmerkungen: |
Date Completed 17.04.2019 Date Revised 17.04.2019 published: Print-Electronic CommentIn: J Urol. 2018 Mar;199(3):712. - PMID 29253358 Citation Status MEDLINE |
---|
doi: |
10.1016/j.juro.2017.10.014 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM277010802 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM277010802 | ||
003 | DE-627 | ||
005 | 20231225013244.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231225s2018 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1016/j.juro.2017.10.014 |2 doi | |
028 | 5 | 2 | |a pubmed24n0923.xml |
035 | |a (DE-627)NLM277010802 | ||
035 | |a (NLM)29032296 | ||
035 | |a (PII)S0022-5347(17)77718-X | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Gansler, Ted |e verfasserin |4 aut | |
245 | 1 | 0 | |a Most Gleason 8 Biopsies are Downgraded at Prostatectomy-Does 4 + 4 = 7? |
264 | 1 | |c 2018 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 17.04.2019 | ||
500 | |a Date Revised 17.04.2019 | ||
500 | |a published: Print-Electronic | ||
500 | |a CommentIn: J Urol. 2018 Mar;199(3):712. - PMID 29253358 | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved. | ||
520 | |a PURPOSE: Nonrepresentative biopsy sampling of prostate cancers with a biopsy Gleason score of 8 can adversely influence decisions regarding androgen deprivation in men receiving primary radiation therapy. The frequency of and factors associated with downgrading Gleason 8 biopsies at prostatectomy are not well known | ||
520 | |a MATERIALS AND METHODS: We used records from NCDB (National Cancer Database), a hospital based registry in the United States, of 72,556 men with prostate cancer diagnosed from 2010 to 2013, including 5,474 with Gleason 8 biopsies and no other high progression risk criteria according to NCCN (National Comprehensive Cancer Network®) Guidelines®. The prevalence of Gleason 8 downgrading was calculated. Generalized estimating equation multivariable regression models were used to estimate the prevalence ratios and 95% CIs of downgrading by demographic and clinical factors, and evaluate the association of Gleason 8 downgrading with cT (clinical T) to pathological T category up staging | ||
520 | |a RESULTS: Of 5,474 Gleason 8 biopsies in men lacking other high progression risk criteria 3,263 (60%) were downgraded, changing the progression risk category from high to intermediate. A higher prevalence of Gleason 8 downgrading was significantly and independently associated with decreasing age, African American race, lower cT category, lower prostate specific antigen quartile and certain combinations of primary and secondary Gleason grades (3 + 5 greater than 4 + 4 greater than 5 + 3). Gleason 8 downgrading in cases of cT less than 3 was independently and significantly associated with a lower prevalence of up staging (prevalence ratio = 0.65, 95% CI 0.61-0.69) | ||
520 | |a CONCLUSIONS: Downgrading Gleason 8 biopsies is common. Patient evaluation based on Gleason 8 biopsies often results in overestimating progression risk and disease extent, which may lead to overtreatment | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Multicenter Study | |
650 | 4 | |a biopsy | |
650 | 4 | |a disease progression | |
650 | 4 | |a neoplasm grading | |
650 | 4 | |a prostatic neoplasms | |
650 | 4 | |a risk | |
650 | 7 | |a Prostate-Specific Antigen |2 NLM | |
650 | 7 | |a EC 3.4.21.77 |2 NLM | |
700 | 1 | |a Fedewa, Stacey |e verfasserin |4 aut | |
700 | 1 | |a Qi, Robert |e verfasserin |4 aut | |
700 | 1 | |a Lin, Chun Chieh |e verfasserin |4 aut | |
700 | 1 | |a Jemal, Ahmedin |e verfasserin |4 aut | |
700 | 1 | |a Moul, Judd W |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t The Journal of urology |d 1945 |g 199(2018), 3 vom: 15. März, Seite 706-712 |w (DE-627)NLM000006890 |x 1527-3792 |7 nnns |
773 | 1 | 8 | |g volume:199 |g year:2018 |g number:3 |g day:15 |g month:03 |g pages:706-712 |
856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.juro.2017.10.014 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 199 |j 2018 |e 3 |b 15 |c 03 |h 706-712 |