ASCO GU 2018: Occurrence of pathologic stage T3 disease at radical prostatectomy with ISUP grade group 1 (Gleason 3+3=6) prostate cancer

San Francisco, CA (UroToday.com) In this study, the authors focus on outcomes in men with Gleason grade 1 (Gleason score 3+3=6) prostate cancer at the time of final pathology from radical prostatectomy specimens. With growing interest in how best to classify patients with Gleason Grade 1 disease, with some arguing that its clinical course deems it a benign tumor rather than true malignancy, the authors wanted to assess the clinical outcomes of this unique subset of men in their own institutional series. However, it should be noted that in most prior studies, patients with Gleason Grade 1 who progressed to metastatic disease were found to have higher grade disease on pathology re-review, which makes a discussion in this area somewhat difficult.

The authors reviewed their dataset of 1127 consecutive radical prostatectomies performed between 2012−2015 at various community and academic medical centers in the region (Chicago). Of these, 314 patients were found to have ISUP Gleason Grade 1 disease on final pathology (without centralized pathology review).

Importantly, in this cohort, only 4.1% had pT3 disease (12 patients stage pT3a and 1 stage pT3b). As such, men with with pT3 Gleason 3+3=6 PCa represent a small fraction of all radical prostatectomies completed in the modern era.

However, it should be noted that this study was done in the era of active surveillance. So many Gleason 3+3=6 PCa patients are likely not receiving treatment – hence, these patients were selected for treatment either for symptoms or more aggressive pathology on biopsy. This is actually reassuring, as even in these higher risk patients, there is a very low rate of pT3 disease.

Unfortunately, the authors do not elaborate further on other pathologic findings such as margin positivity, node positivity, etc. Nor do they report long-term clinical outcomes. This limits the utility of their results. But, as it encompasses both academic and community practice, it is reassuring that community practice mirrors academic practice.

Speaker: David Greenwald

Co-authors: Alice Y. Wang, Jason Huang, Harpreet Wadhwa, Tony Nimeh, Justin J. Cohen, Paul Yonover

Institution(s): University of Illinois at Chicago, Chicago, IL; Vanderbilt University, Nashville, TN; Uropartners, Chicago, IL

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
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