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The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer

Authors
 Won Sik Jang  ;  Dong Hoon Koh  ;  Jongchan Kim  ;  Jong Soo Lee  ;  Doo Yong Chung  ;  Won Sik Ham  ;  Koon Ho Rha  ;  Young Deuk Choi 
Citation
 PROSTATE, Vol.79(16) : 1805-1810, 2019 
Journal Title
 PROSTATE 
ISSN
 0270-4137 
Issue Date
2019
Keywords
Gleason grade ; biochemical recurrence ; needle biopsy ; prostate cancer ; radical prostatectomy
Abstract
BACKGROUND: Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC. METHODS: We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan-Meier methods and Cox proportional hazard models. RESULTS: Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan-Meier curves showed significant differences in biochemical recurrence (BCR)-free survival across the groups (P < .001). In the multivariate analyses, these groups were significantly associated with BCR (4 + 3/3 + 4: hazard ratio [HR], 1.675; 3 + 4/4 + 3: HR, 1.908; and 4 + 3/4 + 3: HR, 2.699). CONCLUSIONS: Downgrading and upgrading from NB to RP was an independent predictor of BCR in men with GS 7 PC, which could be due to the amount of Gleason pattern 4.
Full Text
https://onlinelibrary.wiley.com/doi/full/10.1002/pros.23905
DOI
10.1002/pros.23905
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koh, Dong Hoon(고동훈)
Kim, Jong Chan(김종찬) ORCID logo https://orcid.org/0000-0002-0022-6689
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Lee, Jong Soo(이종수) ORCID logo https://orcid.org/0000-0002-9984-1138
Jang, Won Sik(장원식) ORCID logo https://orcid.org/0000-0002-9082-0381
Chung, Doo Yong(정두용)
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174524
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