Questioning the status quo: Should Gleason Grade Group 1 prostate cancer be considered a "negative core" in pre-radical prostatectomy risk nomograms? An international multicenter analysis.

To assess the impact of excluding Gleason Grade Group 1 (GG1) prostate cancer (PCa) cores from current pre-radical prostatectomy (RP) nomograms.

Multi-institutional retrospective chart review performed on all RP patients with prostate biopsy between 2008-2018.

Patients individually assessed using Memorial Sloan Kettering Cancer Center (MSKCC) and Briganti nomograms using the following iterations: 1) Original [ORIG] - all available core data and 2) Selective [SEL] - GG1 cores considered negative. Nomogram outcomes, lymph node invasion - LNI, extracapsular extension - ECE, organ-confined disease - OCD, seminal vesicle invasion - SVI, compared across iterations and stratified based on biopsy GG. Clinically significant impact on management (CSIM) defined as change in LNI risk above or below 2% or 5% (Δ2/Δ5). Nomogram outcomes validated with RP pathology.

7718 men met inclusion criteria. In men with GG2 who also had GG1 cores, SEL better predicted LNI (MSKCC - ORIG 4.97% vs. SEL 3.50%; Briganti - ORIG 4.81% vs. SEL 2.49%, RP outcome 2.46%), ECE (MSKCC - ORIG 40.91% vs. SEL 48.44%, RP outcome: 68.46%) and OCD (MSKCC - ORIG 57.87% vs. SEL 50.38%, RP outcome: 30.41%), but not SVI (MSKCC - ORIG 5.42% vs. SEL 3.34%, RP outcome: 5.62%). This was also consistent in patients with GG3-5 disease. The greatest impact of CSIM was on GG1-2 PCa; Δ2 and Δ5 in GG1 patients was 26.3-31.0% and 1.5-5.2%, respectively, and Δ2 and Δ5 in GG2 patients was 3.4-22.2% and 12.3-13.6%, respectively.

Excluding GG1 PCa cores from pre-RP nomograms better predicts final RP pathologic outcomes. More importantly, this may better reflect extent of true cancer burden.

Urology. 2019 Nov 06 [Epub ahead of print]

Joon Yau Leong, Jaime O Herrera-Caceres, Hanan Goldberg, Elwin Tham, Seth Teplitsky, Leonard G Gomella, Edouard J Trabulsi, Costas D Lallas, Neil E Fleshner, Derya Tilki, Thenappan Chandrasekar

Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia PA, USA., Division of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, Canada., Martini-Klinik Prostate Cancer Center, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia PA, USA. Electronic address: .

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