Gleason Scoring at a Comprehensive Cancer Center: What’s The Difference?

Restricted access

This study attempted to determine whether the Gleason score (GS) assigned at a comprehensive cancer center better predicts risk of biochemical failure (BF) after prostate radiotherapy compared with the GS of the referring institution (RI). Between 1994 and 2007, 1649 men received radiotherapy for prostate cancer at Fox Chase Cancer Center (FCCC). The Cox proportional hazard regression was used for inferences about the relationship of time to BF and GS. Harrell’s C-index (HCI) was used to assess concordance in the Cox regression between predicted and observed events. The discordance rate was 26% for any change in either major or minor Gleason pattern. In the RI GS 2 through 6 group, 79 (8%) patients were upgraded to GS 7. Twenty percent of patients with RI GS 7 were downgraded and 2% were upgraded. In the RI GS 8 through 9 group, 58% were downgraded to GS 6 (12%) or GS 7 (88%). The FCCC GS altered the NCCN risk group assignment in 144 men (9%): 92 (64%) men to lower risk and 52 (36%) to higher risk. FCCC GS was a stronger predictor of BF; the hazard ratios for GS 2 through 6 (ref), 3+4, 4+3, and 8 through 9 were 1.00 (ref), 1.82, 4.14, and 2.92, respectively. In contrast, the hazard ratios for the RI GS were 1.00 (ref), 1.53, 2.44, and 1.76, respectively. FCCC GS (HCI=0.76) had improved performance compared with RI GS (HCI=0.74). Changes in GS were common and the GS assigned by a comprehensive cancer center provided better BF risk stratification and prognostication for patients. Changes in GS may impact treatment recommendations in 9% to 26% of patients.

Correspondence: Mark K. Buyyounouski, MD, MS, Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111. E-mail: mark.buyyounouski@fccc.edu
  • 1.

    StephensonAJKattanMWEasthamJA. Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol2009;27:43004305.

    • Search Google Scholar
    • Export Citation
  • 2.

    ZhouPChenMHMcLeodD. Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Clin Oncol2005;23:69926998.

    • Search Google Scholar
    • Export Citation
  • 3.

    PottersLRoachMIIIDavisBJ. Postoperative nomogram predicting the 9-year probability of prostate cancer recurrence after permanent prostate brachytherapy using radiation dose as a prognostic variable. Int J Radiat Oncol Biol Phys2010;76:10611065.

    • Search Google Scholar
    • Export Citation
  • 4.

    PottersLPurrazzellaRBrusteinS. The prognostic significance of Gleason Grade in patients treated with permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys2003;56:749754.

    • Search Google Scholar
    • Export Citation
  • 5.

    GleasonDF. Histologic grading of prostate cancer: a perspective. Hum Pathol1992;23:273279.

  • 6.

    EpsteinJIAllsbrookWCJrAminMB. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol2005;29:12281242.

    • Search Google Scholar
    • Export Citation
  • 7.

    EpsteinJIPotterSR. The pathological interpretation and significance of prostate needle biopsy findings: implications and current controversies. J Urol2001;166:402410.

    • Search Google Scholar
    • Export Citation
  • 8.

    EdgeSB. AJCC cancer staging manual. New York, NY: Springer; 2010.

  • 9.

    MohlerJLBahnsonRRBostonB. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. J Natl Compr Canc Netw2010;82:162200. To view the most recent version of these guidelines visit NCCN.org.

    • Search Google Scholar
    • Export Citation
  • 10.

    AllsbrookWCJrMangoldKAJohnsonMH. Interobserver reproducibility of Gleason grading of prostatic carcinoma: urologic pathologists. Hum Pathol2001;32:7480.

    • Search Google Scholar
    • Export Citation
  • 11.

    AllsbrookWCJrMangoldKAJohnsonMH. Interobserver reproducibility of Gleason grading of prostatic carcinoma: general pathologist. Hum Pathol2001;32:8188.

    • Search Google Scholar
    • Export Citation
  • 12.

    di LoretoCFitzpatrickBUnderhillS. Correlation between visual clues, objective architectural features, and interobserver agreement in prostate cancer. Am J Clin Pathol1991;96:7075.

    • Search Google Scholar
    • Export Citation
  • 13.

    ThomasCWBainbridgeTCThomsonTA. Clinical impact of second pathology opinion: a longitudinal study of central genitourinary pathology review before prostate brachytherapy. Brachytherapy2007;6:135141.

    • Search Google Scholar
    • Export Citation
  • 14.

    SooriakumaranPLovellDPHendersonA. Gleason scoring varies among pathologists and this affects clinical risk in patients with prostate cancer. Clin Oncol (R Coll Radiol)2005;17:655658.

    • Search Google Scholar
    • Export Citation
  • 15.

    BuyyounouskiMKHorwitzEMPriceRA. Intensity-modulated radiotherapy with MRI simulation to reduce doses received by erectile tissue during prostate cancer treatment. Int J Radiat Oncol Biol Phys2004;58:743749.

    • Search Google Scholar
    • Export Citation
  • 16.

    BuyyounouskiMKHorwitzEMUzzoRG. The radiation doses to erectile tissues defined with magnetic resonance imaging after intensity-modulated radiation therapy or iodine-125 brachytherapy. Int J Radiat Oncol Biol Phys2004;59:13831391.

    • Search Google Scholar
    • Export Citation
  • 17.

    HanksGEHanlonALPinoverWH. Survival advantage for prostate cancer patients treated with high-dose three-dimensional conformal radiotherapy. Cancer J Sci Am1999;5:152158.

    • Search Google Scholar
    • Export Citation
  • 18.

    GuptaDLayfieldLJ. Prevalence of inter-institutional anatomic pathology slide review: a survey of current practice. Am J Surg Pathol2000;24:280284.

    • Search Google Scholar
    • Export Citation
  • 19.

    ManionECohenMBWeydertJ. Mandatory second opinion in surgical pathology referral material: clinical consequences of major disagreements. Am J Surg Pathol2008;32:732737.

    • Search Google Scholar
    • Export Citation
  • 20.

    KronzJDWestraWHEpsteinJI. Mandatory second opinion surgical pathology at a large referral hospital. Cancer1999;86:24262435.

  • 21.

    BrimoFSchultzLEpsteinJI. The value of mandatory second opinion pathology review of prostate needle biopsy interpretation before radical prostatectomy. J Urol2010;184:126130.

    • Search Google Scholar
    • Export Citation
  • 22.

    KuroiwaKShiraishiTOgawaO. Discrepancy between local and central pathological review of radical prostatectomy specimens. J Urol2010;183:952957.

    • Search Google Scholar
    • Export Citation
  • 23.

    KuroiwaKShiraishiTNaitoS; Clinicopathological Research Group for Localized Prostate Cancer I. Gleason score correlation between biopsy and prostatectomy specimens and prediction of high-grade Gleason patterns: significance of central pathologic review. Urology2011;77:407411.

    • Search Google Scholar
    • Export Citation
  • 24.

    D’SouzaNLoblawDAMamedovA. Prostate cancer pathology audits: is central pathology review still warranted?Can J Urol2012;19:62566260.

    • Search Google Scholar
    • Export Citation
  • 25.

    NettoGJEisenbergerMEpsteinJI; TAX 3501 Trial Investigators. Interobserver variability in histologic evaluation of radical prostatectomy between central and local pathologists: findings of TAX 3501 multinational clinical trial. Urology2011;77:11551160.

    • Search Google Scholar
    • Export Citation
  • 26.

    NguyenPLSchultzDRenshawAA. The impact of pathology review on treatment recommendations for patients with adenocarcinoma of the prostate. Urol Oncol2004;22:295299.

    • Search Google Scholar
    • Export Citation
  • 27.

    EpsteinJI. Gleason score 2-4 adenocarcinoma of the prostate on needle biopsy: a diagnosis that should not be made. Am J Surg Pathol2000;24:477478.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 80 80 13
PDF Downloads 3 3 2
EPUB Downloads 0 0 0