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Changes in Gleason score grading and their effect in predicting outcome after radical prostatectomy
Matvey Tsivian1, Leon Sun, Vladimir Mouraviev
1Division of Urology, Department of Surgery, Duke Prostate Center, Durham, North Carolina, USA.
Urology
|July 21, 2009
Summary
Pathologist interpretation significantly shifted Gleason scores (GS) over time. While the contemporary GS is a useful prognostic factor for prostate-specific antigen recurrence (PSAR) when grouped by risk, the single GS value is less important.
Area of Science:
- Uropathology
- Oncology
- Prostate Cancer Research
Background:
- Gleason score (GS) is critical for prostate cancer prognosis.
- Changes in pathological interpretation may affect GS over time.
- The impact of GS reevaluation on patient outcomes needs assessment.
Purpose of the Study:
- To compare original Gleason scores (GS) from the mid-1990s with current pathological reevaluations of prostatectomy slides.
- To evaluate the effect of Gleason score (GS) migration on outcomes in prostate cancer patients.
- To assess the prognostic significance of updated Gleason scores (GS) for prostate-specific antigen recurrence (PSAR).
Main Methods:
- Retrospective review of 204 prostatectomy cases from 1995-1997.
- Blinded reevaluation of prostatectomy slides and Gleason score (GS) reassignment by a single uropathologist in 2008.
- Comparison of original and reassigned Gleason scores (GS) distributions and their predictive ability for prostate-specific antigen recurrence (PSAR).
Main Results:
- Significant differences observed in Gleason score (GS) distributions between initial and reevaluated scores (P < .001).
- Average reevaluated Gleason score (GS) was higher (6.39 vs 6.14), with upgrades in 30.9% and downgrades in 12.3% of cases.
- Initial Gleason score (GS) predicted prostate-specific antigen recurrence (PSAR) (P = .002), but reassigned GS did not (P = .393) as a single value; however, risk-stratified reassigned GS showed significant differences in PSAR.
Conclusions:
- Pathologist interpretation significantly influences Gleason score (GS) shifts.
- Contemporary Gleason scores (GS), when stratified into risk categories, remain valuable prognostic indicators for prostate-specific antigen recurrence (PSAR).
- The prognostic utility of Gleason score (GS) for prostate-specific antigen recurrence (PSAR) is enhanced by risk stratification rather than relying on a single value.
