UroToday- In the August issue of Urology, Dr. Kang and associates from the SEARCH database report that Gleason score 7(4+3) CaP has a similar risk profile to Gleason (4+4). A Gleason cohort of 374 men was studied and included men with a Gleason score of 3+4, 4+3, or 4+4 or more. Clinical, pathologic, and biochemical outcomes were assessed in univariate and microvariate analysis.

A biopsy Gleason score of 4+3 was associated with higher risk disease than was 3+4 as noted by higher pathologic grade and more extracapsular extension (ECE) and seminal vesicle invasion (SVI). No significant differences were identified between Gleason score 4+3 and 4+4 or more in any clinicopathologic characteristic other than for higher grade pathologic tumors in the 4+4 cohort. While Gleason score 4+3 had increased odds of ECE and SVI, the 4+3 group did not differ in ECE, SVI, or positive surgical margins from the 4+4 cohort. During the follow-up period 37% experienced biochemical progression and Gleason score 4+3 were associated with an increased risk of progression relative to 3+4 but it was similar to 4+4. Furthermore, men with an RP Gleason score of 4+3 had an increased risk of progression relative to an RP Gleason score of 3+4, but it was similar to those with an RP score of 4+4. These data suggest that men with a biopsy Gleason score 4+3 should be counseled similar to those with a Gleason score 4+4, due to the risk of adverse pathologic outcomes and tumor progression.

Kang DE, Fitzsimons NJ, Presti JC, Kane CJ, Terris MK, Aronson WJ, Amling CL, Freedland SJ, SEARCH Database Study Group

Urol. 70(2): 277- 282, August 2007
doi:10.1016/j.urology.2007.03.059

Reported by UroToday Contributing Editor Christopher P. Evans, M.D

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