Affiliation:
1. Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia; S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
2. Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
3. S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
Abstract
Objective: to determine the degree of heterogeneity of prostate cancer Gleason 6 (3 + 3) by assessing: long-term oncological results, mismatch of pre- and postoperative degree of prostate cancer aggressiveness, preoperative clinical component.Materials and methods. 528 patients with clinically localized prostate cancer and Gleason»s preoperative score of 6 (3 + 3). All patients were divided into 3 groups: group 1 (n = 151) — Gleason 6, prostate specific antigen (PSA) density <0.15ng/ml/cm3, ≤4 positive biopsy cores, <50 % lesion of the biopsy cores, group 2 (n = 229) — Gleason 6, PSA <10 ng/ml and group 3 (n = 148) — Gleason 6, PSA >10 ng/ml.Results. Statistically significant differences between group 1 and group 2 were observed only when assessing PSA velocity (p <0.017). The median time to the development of biochemical relapse (BCR) in the study population was 12 (3—77) months. BCR in group 1 was observed in 1.98 % of patients, in group 2 and 3 — 7.86 and 14.19 %, respectively. Statistically significant differences in the time of onset of BCR within 2 years after surgery were found between groups 1 and 2 (p = 0.002) and group 1 and 3 (p = 0.0001). An increase in the degree of malignancy after surgery in group 1 was determined only in 13 % of patients, in group 2 in 27 %, in group 3 in 43 % of patients. The contribution of a greater postoperative degree of malignancy of prostate cancer to the development of BCR in group 1 was 1.32 % (2 out of 3 patients). Thus, in group 1 in the case of true Gleason 6 (3 + 3), the probability of BCR was 0.66 %.Conclusion. PSA velocity before surgery showed a statistical difference between groups 1 and 2. Based on long-term oncological results after surgery, heterogeneous behavior of the tumor is observed among the study groups. Group 1 in comparison with group 2 and 3 showed the lowest frequency of increase in the Gleason score and the likelihood of developing BCR after surgery. These results may be useful in planning an individual patient treatment plan.
Publisher
Publishing House ABV Press
Subject
Urology,Nephrology,Radiology, Nuclear Medicine and imaging,Oncology,Surgery
Reference30 articles.
1. Partin A.W., Kattan M.W., Subong E.N. et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multiinstitutional update. JAMA 1997;277(18):1445-51.
2. Sved P.D., Gomez P., Manoharan M. et al. Limitations of biopsy Gleason grade: implications for counseling patients with biopsy Gleason score 6 prostate cancer. J Urol 2004;172(1):98-102. DOI: 10.1097/01.ju.0000132135.18093.d6.
3. Tavangar S.M., Raz A., Mashayekhi R. Correlation between prostate needle biopsy and radical prostatectomy Gleason gradings of 111 cases with prostatic adenocarcinoma. Urol J 2004;1(4):246-9.
4. Shen B.Y., Tsui K.H., Chang P.L. et al. Correlation between the Gleason scores of needle biopsies and radical prostatectomy specimens. Chang Gung Med J 2003;26(12):919-24.
5. Henderickx M.M.E.L., Brits T., Muilwijk T. et al. Localized prostate cancer and robot-assisted laparoscopic radical prostatectomy: a retrospective, comparative study between pre- and postoperative Gleason scores. Acta Chir Belg 2018;118(1):15-20. DOI: 10.1080/00015458.2017.1353234.