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Mortality Risk for Patients with Biopsy Gleason Grade Group 1 Prostate Cancer.

Derya Tilki1, Ming-Hui Chen2, Hartwig Huland3

  • 1Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey.

European Urology Oncology
|July 3, 2024
PubMed
Summary
This summary is machine-generated.

High prostate-specific antigen (PSA) levels or over 50% positive biopsies in Gleason Grade Group 1 prostate cancer patients indicate a higher risk of aggressive disease and mortality. Consider rebiopsy for this subgroup to identify potentially unsampled high-grade cancer.

Keywords:
Gleason grade groupMortalityProstate cancer

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Area of Science:

  • Urology
  • Oncology
  • Pathology

Background:

  • Gleason Grade Group 1 (GGG1) prostate cancer (PC) diagnosed via systematic biopsy (SBx) or combined biopsy (CBx) may harbor unsampled high-risk disease.
  • Clinical factors at presentation are crucial for identifying patients with potential understaged PC following radical prostatectomy.

Purpose of the Study:

  • To investigate the association between clinical factors at presentation and the presence of unsampled high-risk PC.
  • To assess the relationship between these factors and PC-specific mortality (PCSM) and all-cause mortality (ACM) after radical prostatectomy in GGG1 PC patients.

Main Methods:

  • A cohort study of 10,228 patients treated for GGG1 PC at a German university hospital.
  • Logistic, Fine and Gray, and Cox regression models were used to analyze associations with adverse pathology, early PSA failure, PCSM, and ACM.

Main Results:

  • Percent positive biopsies (PPB) >50% and PSA >20 ng/ml were significantly associated with higher risks of adverse pathology and early PSA failure, irrespective of biopsy approach.
  • In the SBx group, PPB >50% and PSA >20 ng/ml were also linked to increased risks of PCSM and ACM (p ≤ 0.04).
  • Approximately 1 in 12 patients with GGG1 PC on biopsy may have more aggressive cancer than initially detected.

Conclusions:

  • Patients with GGG1 PC and either PPB >50% or PSA >20 ng/ml represent a subgroup at increased risk.
  • Maintaining the "cancer" classification and considering rebiopsy for these patients may help identify unsampled high-grade disease and mitigate mortality risk.