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ORIGINAL ARTICLE
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 203-208

Incidence of metastasis and prostate-specific antigen levels at diagnosis in Gleason 3+4 versus 4+3 prostate cancer


1 Department of Urology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Urology, College of Medicine, Ain Shams University, Cairo, Egypt, USA
2 Department of Urology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Urology, College of Medicine, Ain Shams University, Cairo, Egypt
3 Department of Urology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
4 Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Correspondence Address:
Dr. Mohamed H Kamel
Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham #540, Little Rock, AR 72205
USA
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DOI: 10.4103/UA.UA_124_17

PMID: 29719335

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Aims: The aim is to assess for a difference in the incidence of metastasis (IM) and prostate-specific antigen (PSA) levels at diagnosis in patients with Gleason score (GS) 3+4 versus 4+3 prostate cancer using a large veterans affairs database. Subjects and Methods: A retrospective review of 1402 medical records from 5 VA hospitals was conducted. The study period was from 2009 to 2014. Primary endpoints were IM and PSA levels at diagnosis. A secondary endpoint was overall survival. Statistical Analysis Used: Chi-square tests for categorical variables, Student's t-test for continuous, normally distributed variables, and rank sum tests for continuous nonnormally distributed variables. Results: There were 1050 patients with GS3+4 and 352 with GS4+3. There were no differences in sociodemographic and clinical characteristics of the study population. PSA at the time of diagnosis was significantly higher in the GS4+3 patients compared to GS3+4 (18.0 vs. 11.4, respectively; P < 0.001). The IM at diagnosis was higher in the GS4+3 patients (10/352) compared to GS3+4 (9/1041) (2.8% vs. 0.9%; P = 0.005). In an adjusted model, GS4+3 was associated with higher PSA, higher IM at diagnosis. There was no difference in overall survival between the 2 groups though a 23% reduction in overall survival in the GS4+3 was noted (P = 0.53). Conclusions: Our results indicate that patients with GS4+3 prostate cancers have higher PSA levels at diagnosis. GS4+3 is associated with 3-fold increased risk of IM at diagnosis than GS3+4 though the overall incidence is low. Further research is needed to assess whether GS4+3 patients need routine staging imaging investigations at the time of diagnosis similar to patients with higher Gleason scores (GS ≥8).


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