Impact of ISUP grade group on cancer-specific mortality in radical prostatectomy-treated prostate cancer patients with organ-confined disease

Authors

  • Francesco Barletta San Raffaele Hospital
  • Stefano Tappero
  • Simone Morra
  • Reha-Baris Incesu
  • Cristina Cano Garcia
  • Mattia Luca Piccinelli
  • Lukas Scheipner
  • Zhe Tian
  • Giorgio Gandaglia
  • Armando Stabile
  • Elio Mazzone
  • Carlo Terrone
  • Nicola Longo
  • Derya Tilki
  • Felix K.H. Chun
  • Ottavio De Cobelli
  • Sascha Ahyai
  • Fred Saad
  • Shahrokh F. Shariat
  • Francesco Montorsi
  • Alberto Briganti
  • Pierre I. Karakiewicz

DOI:

https://doi.org/10.5489/cuaj.8941

Keywords:

SEER program, Prostate cancer, ISUP grade group, Organ confined

Abstract

INTRODUCTION: We aimed to test the impact of International Society of Urological Pathology (ISUP) grade group (GG) on cancer-specific mortality (CSM) in organ-confined (pT2) prostate cancer (PCa) at radical prostatectomy (RP).

METHODS: RP organ-confined PCa patients were identified (Surveillance, Epidemiology, and End Results [SEER] 2004−2015). Cancer-specific survival (CSS) rates were tested in Kaplan-Meier plots and multivariable Cox regression (MCR) models according to GG: 1–3 vs. 4 vs. 5. Sensitivity analyses addressed GG4 and GG5 patients with available primary and secondary Gleason score (GS).

RESULTS: Overall, 61 172 patients with RP organ-confined PCa were identified. Of these, 57 715 (94.4%), 2036 (3.3%) and 1421 (2.3%) harbored GG1–3, 4, and 5, respectively. In Kaplan-Meier analyses, seven-year’ CSS estimates were 99.6 vs. 98.2 vs. 93.8% for GG1–3 vs. 4 vs. 5, respectively (p<0.001). In MCR models, GG4 (hazard ratio [HR] 2.72, p<0.001) and 5 (HR 9.95, p<0.001) independently predicted higher CSM, relative to GG1–3. Furthermore, GG5 also independently predicted higher CSM (HR 3.72, p<0.001) vs. GG4. In sensitivity analyses, 1.2, 1.6, and 2.4 CSM events per 1000 person-years of followup were respectively recorded for GS 4+4, 3+5, and 5+3 patients. Conversely, 4.8 vs. 5.3 CSM events per 1000 person-years of followup were respectively recorded for GS 4+5 vs. 5+4/5+5 patients.

CONCLUSIONS: In organ-confined PCa, at RP, a small proportion of patients harbor GG4–5. These patients exhibit higher CSM than their GG1–3 counterparts. Moreover, detectable mortality rate differences indicate a dose-response effect according to primary and secondary GS. This phenomenon applies in both GG4 and GG5, as well as between GG4 and GG5.

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Published

2025-01-14

How to Cite

Barletta, F., Tappero, S., Morra, S., Incesu, R.-B., Cano Garcia, C., Piccinelli, M. L., … Karakiewicz, P. I. (2025). Impact of ISUP grade group on cancer-specific mortality in radical prostatectomy-treated prostate cancer patients with organ-confined disease. Canadian Urological Association Journal, 19(5), E166–71. https://doi.org/10.5489/cuaj.8941

Issue

Vol. 19 No. 5 (2025): CUAJ May

Section

Original Research

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