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What is it about?
The study compares the results of Gleason Grade Group (GGG) classification following central pathology review with previous local pathology assessment in a large patient cohort treated with radiotherapy and short-course hormone therapy. The study found that central pathology-derived GGG stratified biochemical/clinical failure (BCF) and distant metastases (DM) outcomes better than the historical local pathology. The study assessed GS both as an overall and worst score to derive GGG. Overall GS-derived GGG and worst GS-derived GGG, gave very similar results for both BCF and development of DM. However the small proportion of patients upgraded from GGG2 to GGG3 when using the worst GS had similar outcomes to the overall GGG3 group. The study recommends using both overall and worst GS to derive GGG.
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Why is it important?
This research is important because it highlights the importance of using the ISUP Gleason Grade Groups for the accurate diagnosis and prognosis of patients with prostate cancer. The study demonstrates that specialist histopathology review using contemporary guidelines outperforms historical local histopathology assessments, with resultant Gleason Grades (GGGs) more clearly associated with both biochemical failure (BCF) and the development of distant metastases (DM). This finding has important implications for patient management, as the distinction between Gleason Grades 2 and 3 may be clinically significant, changing the National Comprehensive Cancer Network (NCCN) risk group from favorable to unfavorable intermediate risk. Key Takeaways: 1. Central pathology review using contemporary guidelines outperforms historical local pathology assessments in the diagnosis and prognosis of prostate cancer. 2. ISUP Gleason Grade Groups better stratify patients with regard to both BCF-free and DM-free outcomes than Gleason scores. 3. Patients upgraded from Gleason Grade Group 2 to 3 using worst biopsy Grade Group segregate with Gleason Grade Group 3 on long-term follow-up. 4. The use of both overall and worst Gleason Score to derive Gleason Grade Group is recommended
Perspectives
Large phase 3 clinical trials give the opportunity for translational research. This analysis from the CHHiP trial has confirmed the value of the ISUP grade grouping system and emphasises the importance of the histopathologist in the multi-disciplinary team. I hope it usefully adds to MDT discussions and clinical decision making. The centrally reviewed pathology will be used as the foundation for on-going research assessing the potential roles of novel tissue and genetic biomarkers as well as digital pathology in localised prostate cancer.
David Dearnaley
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Read the Original
This page is a summary of: International Society of Urological Pathology (ISUP) Gleason Grade Groups stratify outcomes in the CHHiP Phase 3 prostate radiotherapy trial, BJU International, August 2023, Wiley,
DOI: 10.1111/bju.16133.
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