The value of the 2005 International Society of Urological Pathology (ISUP) modified Gleason grading system as a predictor of biochemical recurrence after radical prostatectomy

• Published in: International urology and nephrology Vol. 46; no. 5; pp. 935 - 940
• Main Authors: Billis, Athanase, Quintal, Maisa M.Q., Meirelles, Luciana, Freitas, Leandro L.L., Costa, Larissa B.E., Bonfitto, João F.L., Diniz, Betina L., Poletto, Paola H., Magna, Luís A., Ferreira, Ubirajara
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.05.2014; Springer Nature B.V
• Subjects: Biopsy, Needle; Carcinoma - blood; Carcinoma - pathology; Carcinoma - surgery; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Neoplasm Grading; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - pathology; Nephrology; Practice Guidelines as Topic; Proportional Hazards Models; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Retrospective Studies; Risk Assessment; Time Factors; Urology; Urology - Original Paper; Adenocarcinoma; Prostatectomy; Prostatic neoplasms; Prostate; Needle biopsy
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-013-0579-8

Purpose To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS). Methods Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan–Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model. Results Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan–Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor. Conclusions The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.