Department of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, US.
Department of Pathology, St Luke's University Health Network-Specialty Lab, Bethlehem, PA, US.
Am J Clin Pathol. 2023 Jul 5;160(1):35-40. doi: 10.1093/ajcp/aqad005.
To determine the prognostic significance of the maximum allowable percentage of Gleason pattern 4 (GP4) at prostate biopsy compared with adverse pathology observed at radical prostatectomy (RP) to expand active surveillance eligibility among a cohort with intermediate risk of prostate cancer.
A retrospective study of patients with grade group (GG) 1 or 2 prostate cancer on prostate biopsy with subsequent RP was performed at our institution. A Fisher exact test was used to understand the relationship among GP4 subgroups (0%, ≤5%, 6%-10%, and 11%-49%) assigned at biopsy and adverse pathologic findings at RP. Additional analyses comparing the GP4 ≤5% cohort's prebiopsy prostate-specific antigen (PSA) level and GP4 length with adverse pathology at RP were also performed.
No statistically significant difference in adverse pathology at RP was observed between the active surveillance-eligible control (GP4 0%) and the GP4 ≤5% subgroup. In total, 68.9% of the GP4 ≤5% cohort showed favorable pathologic outcomes. A separate analysis of the GP4 ≤5% subgroup revealed that neither prebiopsy serum PSA levels nor GP4 length showed statistical correlation with adverse pathology at RP.
Active surveillance may be a reasonable option for management of patients in the GP4 ≤5% group until long-term follow-up data become available.
确定前列腺活检中最大允许的格里森模式 4（GP4）百分比与根治性前列腺切除术（RP）中观察到的不良病理之间的预后意义，以扩大具有中等前列腺癌风险的队列中主动监测的资格。
对本机构进行的前列腺活检为 GG1 或 2 级前列腺癌且随后行 RP 的患者进行了回顾性研究。Fisher 确切检验用于了解活检时分配的 GP4 亚组（0%、≤5%、6%-10%和 11%-49%）与 RP 时不良病理发现之间的关系。还进行了比较 GP4 ≤5%组患者的前列腺特异性抗原（PSA）水平和 GP4 长度与 RP 时不良病理的其他分析。
在 RP 时的不良病理方面，符合主动监测标准的对照组（GP4 0%）与 GP4 ≤5%亚组之间没有统计学差异。总的来说，GP4 ≤5%组中 68.9%的患者表现出有利的病理结果。对 GP4 ≤5%亚组的单独分析表明，RP 时的不良病理与术前血清 PSA 水平或 GP4 长度均无统计学相关性。
在长期随访数据可用之前，主动监测可能是 GP4 ≤5%组患者管理的合理选择。
