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Lack of association of prostate carcinoma nuclear grading with prostate specific antigen recurrence after radical prostatectomy.
J Urol. 2001 Dec; 166(6):2193-7.JU

Abstract

PURPOSE

Grading prostate cancer using the Gleason system relies only on architectural tumor growth, in contrast to other systems, such as the WHO system, which grade prostate carcinoma based on nuclear features as well as architectural patterns. The prognostic significance of nuclear grading remains controversial since most studies were performed before prostate specific antigen (PSA) screening became widely available. We evaluated the significance of nuclear grade for predicting PSA recurrence in a contemporary cohort of patients treated with radical prostatectomy for clinically localized prostate carcinoma.

MATERIALS AND METHODS

Nuclear grades 1 to 3 were determined in 141 consecutive radical prostatectomies in 1995. Predominant and worst nuclear grade was determined by a consensus of 3 pathologists. Statistical analysis compared nuclear grade with Gleason score using the chi-square test. The Cox proportional hazards analysis was performed to calculate the ability of nuclear grade, Gleason score and other variables to predict PSA recurrence.

RESULTS

We identified a significant association of Gleason score with worst nuclear grade (p = 0.007). All 6 cases with a Gleason score of 8 or greater had a worst nuclear grade of 3, in contrast to 36 of 60 (60%) with a score 6 or less, in which the worst nuclear grade was 3. Of the 141 patients 31 (21.9%) had PSA recurrence at a median followup of 3.7 years. The univariate Cox model revealed significant associations of PSA recurrence with Gleason score 8 or greater (hazards ratio 5.5, p = 0.005), extraprostatic extension (hazards ratio 3.4, p = 0.001), positive surgical margin (hazards ratio 2.6, p = 0.009), seminal vesicle involvement (hazards ratio 7.3, p <0.001), preoperative serum PSA (hazards ratio 1.03, p = 0.007), tumor stage (hazards ratio 3.6, p = 0.001) and maximal tumor dimension (hazards ratio 2.4, p <0.001). However, overall and worst nuclear grade did not predict PSA recurrence (p = 0.89 and 0.13, respectively). Nuclear grade did not fit any multivariate model tested, which otherwise included Gleason score, log(PSA), surgical margin status, extraprostatic extension, seminal vesicle status, tumor size and pathological stage. By varying sample fixation time we also showed that benign prostate tissue in the same section as prostate carcinoma had grade 2 or 3 nuclear changes, that is moderate to marked anaplasia.

CONCLUSIONS

High nuclear grade is associated with high Gleason score. However, prostate carcinoma with a Gleason score of 6 or less shows extreme variability. Nuclear grade determined by light microscopy failed to predict PSA recurrence in a contemporary series of men with clinically localized prostate cancer treated with radical prostatectomy. Nuclear morphology is subject to tissue fixation and processing artifact. Any nuclear morphometric study must consider this artifact.

Authors+Show Affiliations

Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11696734

Citation

Zhou, M, et al. "Lack of Association of Prostate Carcinoma Nuclear Grading With Prostate Specific Antigen Recurrence After Radical Prostatectomy." The Journal of Urology, vol. 166, no. 6, 2001, pp. 2193-7.
Zhou M, Hayasaka S, Taylor JM, et al. Lack of association of prostate carcinoma nuclear grading with prostate specific antigen recurrence after radical prostatectomy. J Urol. 2001;166(6):2193-7.
Zhou, M., Hayasaka, S., Taylor, J. M., Shah, R., Proverbs-Singh, T., Manley, S., & Rubin, M. A. (2001). Lack of association of prostate carcinoma nuclear grading with prostate specific antigen recurrence after radical prostatectomy. The Journal of Urology, 166(6), 2193-7.
Zhou M, et al. Lack of Association of Prostate Carcinoma Nuclear Grading With Prostate Specific Antigen Recurrence After Radical Prostatectomy. J Urol. 2001;166(6):2193-7. PubMed PMID: 11696734.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lack of association of prostate carcinoma nuclear grading with prostate specific antigen recurrence after radical prostatectomy. AU - Zhou,M, AU - Hayasaka,S, AU - Taylor,J M, AU - Shah,R, AU - Proverbs-Singh,T, AU - Manley,S, AU - Rubin,M A, PY - 2001/11/7/pubmed PY - 2002/1/5/medline PY - 2001/11/7/entrez SP - 2193 EP - 7 JF - The Journal of urology JO - J Urol VL - 166 IS - 6 N2 - PURPOSE: Grading prostate cancer using the Gleason system relies only on architectural tumor growth, in contrast to other systems, such as the WHO system, which grade prostate carcinoma based on nuclear features as well as architectural patterns. The prognostic significance of nuclear grading remains controversial since most studies were performed before prostate specific antigen (PSA) screening became widely available. We evaluated the significance of nuclear grade for predicting PSA recurrence in a contemporary cohort of patients treated with radical prostatectomy for clinically localized prostate carcinoma. MATERIALS AND METHODS: Nuclear grades 1 to 3 were determined in 141 consecutive radical prostatectomies in 1995. Predominant and worst nuclear grade was determined by a consensus of 3 pathologists. Statistical analysis compared nuclear grade with Gleason score using the chi-square test. The Cox proportional hazards analysis was performed to calculate the ability of nuclear grade, Gleason score and other variables to predict PSA recurrence. RESULTS: We identified a significant association of Gleason score with worst nuclear grade (p = 0.007). All 6 cases with a Gleason score of 8 or greater had a worst nuclear grade of 3, in contrast to 36 of 60 (60%) with a score 6 or less, in which the worst nuclear grade was 3. Of the 141 patients 31 (21.9%) had PSA recurrence at a median followup of 3.7 years. The univariate Cox model revealed significant associations of PSA recurrence with Gleason score 8 or greater (hazards ratio 5.5, p = 0.005), extraprostatic extension (hazards ratio 3.4, p = 0.001), positive surgical margin (hazards ratio 2.6, p = 0.009), seminal vesicle involvement (hazards ratio 7.3, p <0.001), preoperative serum PSA (hazards ratio 1.03, p = 0.007), tumor stage (hazards ratio 3.6, p = 0.001) and maximal tumor dimension (hazards ratio 2.4, p <0.001). However, overall and worst nuclear grade did not predict PSA recurrence (p = 0.89 and 0.13, respectively). Nuclear grade did not fit any multivariate model tested, which otherwise included Gleason score, log(PSA), surgical margin status, extraprostatic extension, seminal vesicle status, tumor size and pathological stage. By varying sample fixation time we also showed that benign prostate tissue in the same section as prostate carcinoma had grade 2 or 3 nuclear changes, that is moderate to marked anaplasia. CONCLUSIONS: High nuclear grade is associated with high Gleason score. However, prostate carcinoma with a Gleason score of 6 or less shows extreme variability. Nuclear grade determined by light microscopy failed to predict PSA recurrence in a contemporary series of men with clinically localized prostate cancer treated with radical prostatectomy. Nuclear morphology is subject to tissue fixation and processing artifact. Any nuclear morphometric study must consider this artifact. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/11696734/Lack_of_association_of_prostate_carcinoma_nuclear_grading_with_prostate_specific_antigen_recurrence_after_radical_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)65533-4 DB - PRIME DP - Unbound Medicine ER -