Heterogeneity of contemporary grade group 4 prostate cancer in radical prostatectomy specimens.

The aim was to evaluate the prognostic role of sub-categories of ISUP 4 prostate cancer (PCa) on final pathology, and assess the tumor architecture prognostic role for predicting biochemical recurrence (BCR) after radical prostatectomy.

From a prospectively-maintained database, we included 370 individuals with ISUP 4 on final pathology. The main outcomes were to evaluate the relationship between different ISUP patterns within the group 4 with pathological and oncological outcomes. Binary logistic regression and Kaplan-Meier estimator were used to evaluate the role of the different categories (3 + 5, 4 + 4, 5 + 3) and tumor architecture (intraductal and/or cribriform) on pathological and oncological outcomes.

Among the 370 individuals with ISUP considered for the study, 9, 85 and 6% had grade 3 + 5, 4 + 4 and 5 + 3 PCa, respectively. Overall, 74% had extracapsular extension, while lymph node invasion (LNI) was documented in 9%. A total of 144 patients experienced BCR during follow-up. After adjusting for PSA, pT, grade group, LNI and positive surgical margins (PSM), grade 3 + 5 was a protective factor (HR: 0.30, 95% CI: 0.13,0.68, p = 0.004) in predicting BCR relative to grade 4 + 4. Intraductal or cribriform architecture was correlated with BCR (HR: 5.99, 95% CI: 2.68, 13.4, p < 0.001) after adjusting for PSA, pT, grade group, LNI and PSM.

Patients with tumor grade 3 + 5 had better pathological and prognostic outcomes compared to 4 + 4 or 5 + 3. When accounting for tumor architecture, the sub-stratification into subgroups lost its prognostic role and tumor architecture was the sole predictor of poorer prognosis in terms of biochemical recurrence.

World journal of urology. 2022 Nov 07 [Epub ahead of print]

Alberto Martini, Alae Touzani, Jean-Baptiste Beauval, Alain Ruffion, Jonathan Olivier, Anis Gasmi, Charles Dariane, Matthieu Thoulouzan, Eric Barret, Laurent Brureau, Gilles Créhange, Gaëlle Fiard, Mathieu Gauthé, Raphaële Renard-Penna, Guilhem Roubaud, Paul Sargos, Mathieu Roumiguié, Marc-Olivier Timsit, Romain Mathieu, Arnauld Villers, Morgan Rouprêt, Gaëlle Fromont, Guillaume Ploussard, CC-AFU, Cancerology Committee of the Association Française d’Urologie

Department of Urology, La Croix du Sud Hospital, 52, Chemin de Ribaute, 31130, Quint Fonsegrives, France., Department of Urology, La Croix du Sud Hospital, 52, Chemin de Ribaute, 31130, Quint Fonsegrives, France. ., Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France., Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000, Lille, France., Department of Urology, CHU Rennes, Rennes, France., Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris-Paris University-U1151 Inserm-INEM, Necker, Paris, France., Department of Urology, CHU Toulouse, Toulouse, France., Department of Urology, Institut Mutualiste Montsouris, Paris, France., CHU de Pointe-À-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement Et Travail)-UMR_S 1085, 97110, Pointe-À-Pitre, France., Department of Radiotherapy, Institut Curie, Paris, France., Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France., Unité de Recherche Clinique en Économie de la Santé, CRESS METHODS INSERM UMR 1153, Paris, France., Sorbonne University, AP-HP, Radiology, Pitie-Salpetriere Hospital, F-75013, Paris, France., Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France., Department of Radiotherapy, Institut Bergonié, 33000, Bordeaux, France., Department of Urology, Univ. Lille, CHU Lille, 59000, Lille, France., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013, Paris, France., Department of Pathology, CHRU Tours, Tours, France.

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