Biopsy in Predicting Adverse Pathology on Radical Prostatectomy: Application in Active Surveillance

Authors

Jeffrey Ordner, Department of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, US
Abdallah Flaifel, Department of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, US
Antonio Serrano, Department of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, US, Department of Pathology, St Luke’s University Health Network–Specialty Lab, Bethlehem, PA, US
Rebecca Graziano, Department of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, US
Jonathan Melamed, Department of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, US
Fang-Ming Deng, Department of Pathology, NYU Langone Medical Center, New York University School of Medicine, New York, US

Document Type

Article

Abstract

Objectives: To determine the prognostic significance of the maximum allowable percentage of Gleason pattern 4 (GP4) at prostate biopsy compared with adverse pathology observed at radical prostatectomy (RP) to expand active surveillance eligibility among a cohort with intermediate risk of prostate cancer.

Methods: A retrospective study of patients with grade group (GG) 1 or 2 prostate cancer on prostate biopsy with subsequent RP was performed at our institution. A Fisher exact test was used to understand the relationship among GP4 subgroups (0%, ≤5%, 6%-10%, and 11%-49%) assigned at biopsy and adverse pathologic findings at RP. Additional analyses comparing the GP4 ≤5% cohort’s prebiopsy prostate-specific antigen (PSA) level and GP4 length with adverse pathology at RP were also performed.

Results: No statistically significant difference in adverse pathology at RP was observed between the active surveillance–eligible control (GP4 0%) and the GP4 ≤5% subgroup. In total, 68.9% of the GP4 ≤5% cohort showed favorable pathologic outcomes. A separate analysis of the GP4 ≤5% subgroup revealed that neither prebiopsy serum PSA levels nor GP4 length showed statistical correlation with adverse pathology at RP.

Conclusions: Active surveillance may be a reasonable option for management of patients in the GP4 ≤5% group until long-term follow-up data become available.

First Page

35

Last Page

40

DOI

10.1093/ajcp/aqad005

Publication Date

3-10-2023

Recommended Citation

Ordner J, Flaifel A, Serrano A, Graziano R, Melamed J, Deng FM. Significance of the percentage of gleason pattern 4 at prostate biopsy in predicting adverse pathology on radical prostatectomy: Application in active surveillance. American Journal of Clinical Pathology. 2023 Jul 1;160(1):35-40.