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Front. Oncol. | doi: 10.3389/fonc.2019.01272

Impact of the 2014 International Society of Urological Pathology grading system on concept of high-risk prostate cancer: comparison of long-term oncological outcomes in patients undergoing radical prostatectomy

 Daimantas Milonas1*,  Žilvinas Venclovas2, Inga Gudinaviciene3, Stasys Auskalnis1, Kristina Zviniene4, Nemira Jurkiene4,  Algidas Basevicius4, Ausvydas Patasius5, Mindaugas Jievaltas1 and  Steven Joniau6
  • 1Department of Urology, Lithuanian University of Health Sciences, Lithuania
  • 2Lithuanian University of Health Sciences, Lithuania
  • 3Department of Pathology, Lithuanian University of Health Sciences, Lithuania
  • 4Department of Radiology, Lithuanian University of Health Sciences, Lithuania
  • 5Department of Urology, National Cancer Institute (Lithuania), Lithuania
  • 6Department of Urology, University Hospitals Leuven, Belgium

Objective. To investigate the relationship between the new International Society of Urological Pathology (ISUP) grading system, biochemical recurrence (BCR), clinical progression (CP) and cancer related death (CRD) after open radical prostatectomy (RP) and determine whether the 2014 ISUP grading system influences the concept of high-risk prostate cancer (HRPCa).
Patients and Methods. A total of 1,754 men who underwent RP from 2005 to 2017 were identified from a database at a single tertiary institution. Histopathology reports were reassessed according to the 2014 ISUP grading system. All preoperative, pathological and clinical follow-up data were obtained. Univariable and multivariable Cox regression, Kaplan-Meier and log-rank analyses were performed.
Results. At a median (quartiles) follow-up of 83 (48-123) months, 446 men (25.4%) had BCR, 77 (4.4%) had CP and 39 (2.2%) died from cancer. Grade groups 1, 2, 3, 4 and 5 were detected in 404 (23%), 931 (53.1%), 200 (11.4%), 93 (5.3%) and 126 (7.2%), respectively. 10-year biochemical progression free survival between Grade group 3 and 4 was slightly different (log-rank p = 0.045). There was no difference between Grade groups 3 and 4 comparing 10-year clinical progression free and 10-year cancer specific survival: p=0.82 and p=0.39, respectively. Group 5 had the worst survival rates in comparison with other groups (from p<0.005 to p <0.0001) in all survival analyses.
Pathological stage (hazard ratio (HR) 2.6, p<0.001), positive surgical margins (HR 2.2, p<0.0001) and Grade group (HR 10.4, p<0.0001) were independent predictors for BCR. Stage and Grade group were detected as independent predictors for CP – HR 6.0, p<0.0001 and HR 35.6, p<0.0001, respectively. Only Grade group 5 (HR 12.9, p=0.001) and pT3b (HR 5.9, p=0.001) independently predicted CRD.
Conclusions. The new ISUP 2014 grading system is the most significant independent predictor for BCR, CP and CRD. Grade group 3 and 4 had similar long-term disease progression survival rates and could potentially be stratified in the same risk group. High-risk cancer associated only with group 5.

Keywords: High Risk Prostate Cancer, ISUP 2014 Grade groups, Radical Prostatectomy, Survival, clinical progression

Received: 23 Aug 2019; Accepted: 04 Nov 2019.

Copyright: © 2019 Milonas, Venclovas, Gudinaviciene, Auskalnis, Zviniene, Jurkiene, Basevicius, Patasius, Jievaltas and Joniau. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Daimantas Milonas, Lithuanian University of Health Sciences, Department of Urology, Kaunas, Lithuania, daimantas.milonas@kaunoklinikos.lt