Distinct Prognosis for Gleason Scores 4 + 3 and 3 + 4

Gleason score of 4 + 3 = 7 tied to pathological stage; increases risk of biochemical recurrence

MONDAY, Sept. 26 (HealthDay News) -- A Gleason score of 4 + 3 = 7 is correlated with pathological stage and increased risk of biochemical recurrence after radical prostatectomy (RP), according to a study published in the October issue of The Journal of Urology.

Ali Amin, from the Johns Hopkins Institutions in Baltimore, and colleagues investigated whether the breakdown of Gleason score 7 into 3 + 4 versus 4 + 3 has prognostic significance in predicting the pathological stage and biochemical progression. A total of 1,791 cases with Gleason score 7 on prostatic biopsy identified between 2004 and 2010 were analyzed.

The investigators found that patients' age, preoperative serum prostate specific antigen (PSA), maximum tumor percent per core, and the number of positive cores did not differ between patients with a Gleason score of 3 + 4 = 7 or 4 + 3 = 7. A Gleason score of 4 + 3 = 7 was associated with pathological stage. On multivariate analysis, 4 + 3 = 7, the maximum percent of cancer per core, preoperative PSA, and the number of positive cores were all associated with pathological stage. Gleason score 4 + 3 = 7 on biopsy correlated with an elevated risk of biochemical progression after RP. In multivariable analysis, the maximum percent of cancer per core, preoperative serum PSA, and Gleason score 4 + 3 = 7 were associated with risk of biochemical progression following RP.

"Our study further demonstrates that Gleason score 7 should not be considered a homogenous group for the purposes of disease management and prognosis," the authors write.

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