Association of absolute amount of pattern 4 disease on prostate biopsy with oncologic outcomes in intermediate-risk prostate cancer: A systematic review.

IF 1.9 4区 医学 Q3 UROLOGY & NEPHROLOGY Cuaj-Canadian Urological Association Journal Pub Date : 2025-02-24 DOI:10.5489/cuaj.8995
Melissa Sam Soon, Scott C Morgan, Luke T Lavallee, Rodney H Breau, Trevor A Flood, Mark T Corkum
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Abstract

Introduction: Managing intermediate-risk prostate cancer (IRPC) is challenging due to the heterogeneity in patient outcomes within this risk category. Evaluating the absolute amount of Gleason pattern 4 disease (GP4) at biopsy using the total linear length of pattern 4 (GP4-TL) or absolute percentage of pattern 4 (APP4) may enhance risk stratification. This review aimed to determine if these absolute measures predict oncologic outcomes in IRPC and to identify optimal prognostic thresholds.

Methods: A systematic review was conducted following PRISMA guidelines. Studies included were those reporting the absolute amount of GP4 on biopsy and related outcomes in IRPC patients undergoing surgery or radiotherapy. Outcomes included biochemical recurrence, androgen deprivation therapy (ADT)-free survival, distant metastasis, prostate cancer-specific mortality, all-cause mortality, and adverse pathology.

Results: Seven studies with a total of 2523 patients were included. Analysis revealed that APP4 thresholds were highly predictive of biochemical recurrence, ADT-free survival, and distant metastasis. Both APP4 and GP4-TL were superior to relative %GP4 and Gleason grading (4+3 vs. 3+4) in predicting disease progression and mortality.

Conclusions: The absolute amount of GP4 shows consistent associations with important clinical outcomes and offers an accessible and established method to enhance risk stratification. Further research is needed to define optimal thresholds to guide treatment decisions.

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来源期刊
Cuaj-Canadian Urological Association Journal
Cuaj-Canadian Urological Association Journal 医学-泌尿学与肾脏学
CiteScore
2.80
自引率
10.50%
发文量
167
审稿时长
>12 weeks
期刊介绍: CUAJ is a a peer-reviewed, open-access journal devoted to promoting the highest standard of urological patient care through the publication of timely, relevant, evidence-based research and advocacy information.
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