INTRODUCTION/BACKGROUND: The GS is an established prostate cancer prognostic factor.
Whether the presence of differing GSs at biopsy (eg, 4+3 and 3+3), which we term ComboGS, improves the prognosis that would be predicted based on the highest GS (eg, 4+3) because of decreased upgrading is unknown. Therefore, we evaluated the odds of upgrading at time of radical prostatectomy (RP) and the risk of PCSM when ComboGS was present versus absent.
PATIENTS AND METHODS: Logistic and competing risks regression were performed to assess the effect that ComboGS had on the odds of upgrading at time of RP in the index (n = 134) and validation cohorts (n = 356) and the risk of PCSM after definitive therapy in a long-term cohort (n = 666), adjusting for known predictors of these end points. We calculated and compared the area under the curve using a receiver operating characteristic analysis when ComboGS was included versus excluded from the upgrading models.
RESULTS: ComboGS was associated with decreased odds of upgrading (index: adjusted odds ratio [AOR], 0.14; 95% confidence interval [CI], 0.04-0.50; P = .003; validation: AOR, 0.24; 95% CI, 0.11-0.51; P < .001) and added significantly to the predictive value of upgrading for the in-sample index (P = .02), validation (P = .003), and out-of-sample prediction models (P = .002). ComboGS was also associated with a decreased risk of PCSM (adjusted hazard ratio, 0.40; 95% CI, 0.19-0.85; P = .02).
CONCLUSION: Differing biopsy GSs are associated with a lower odds of upgrading and risk of PCSM. If validated, future randomized noninferiority studies evaluating deescalated treatment approaches in men with ComboGS could be considered.
Written by:
Phillips JG, Aizer AA, Chen MH, Zhang D, Hirsch MS, Richie JP, Tempany CM, Williams S, Hegde JV, Loffredo MJ, D'Amico AV. Are you the author?
Harvard Radiation Oncology Program, Boston, MA; Department of Statistics, University of Connecticut, Storrs, CT; Department of Pathology, Brigham and Women's Hospital, Boston, MA; Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Division of MRI, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.
Reference: Clin Genitourin Cancer. 2014 Mar 3. pii: S1558-7673(14)00041-X.
doi: 10.1016/j.clgc.2014.02.008
PubMed Abstract
PMID: 24721618
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