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Purpose <p>Among Grade Group (GG) 5 prostate cancers (PCa), based on the Gleason grading system, those diagnosed preoperatively with Gleason score (GS) 5 + 4 have been reported to have poorer oncological prognoses compared to those with GS 4 + 5. However, the confounding effects of factors such as serum PSA level and clinical T stage remain unresolved. This study aimed to evaluate the impact of GS 5 + 4 versus 4 + 5 on postoperative prognosis, accounting for potential confounders.</p> Methods <p>This nationwide, multi-institutional retrospective cohort study included 827 patients who underwent robot-assisted radical prostatectomy (RARP) at 25 tertiary centers between 2011 and 2022. Patients were classified by preoperative biopsy as GS 4 + 5 (<i>n</i> = 671) or GS 5 + 4 (<i>n</i> = 156). Biochemical recurrence (BCR)-free survival was compared using inverse probability of treatment weighting (IPTW) and Cox regression, adjusting for age, BMI, PSA, clinical T stage, ASA physical status, and the use of extended lymph node dissection, nerve-sparing, and neoadjuvant hormone therapy.</p> Results <p>The median follow-up was 33.7 months. Adjusted 3- and 5-year BCR-free survival rates were 66.0% and 57.8% for GS 4 + 5, versus 54.8% and 44.6% for GS 5 + 4. GS 5 + 4 remained significantly associated with worse BCR-free survival compared to GS 4 + 5 (HR 1.41, 95% CI 1.04–1.89, <i>p</i> = 0.039).</p> Conclusion <p>Among GG 5 PCa, GS 5 + 4 was associated with significantly poorer BCR-free survival compared to GS 4 + 5, even after adjustment for key confounders. These findings support considering further risk refinement within GG 5.</p>

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Biopsy Gleason score 5 +  4 predicts worse outcomes than 4 + 5 after robot-assisted radical prostatectomy: a nationwide multicenter cohort study

  • 期刊论文

  • 发表日期：

    2026年4月18日

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  • Kimihiro Shimatani,
  • Masashi Kubota,
  • Shingo Yamamoto,
  • Kei Mizuno,
  • Takayuki Sumiyoshi,
  • Ryoichi Saito,
  • Masakatsu Ueda,
  • Ryo Iguchi,
  • Toshifumi Takahashi,
  • Hitoshi Yokozeki,
  • Hiroshi Iwamura,
  • Naoki Kohei,
  • Ryoma Kurahashi,
  • Yuya Sekine,
  • Atsuro Sawada,
  • Hiromitsu Negoro,
  • Shusuke Akamatsu,
  • Takashi Kobayashi,
  • Takayuki Goto

摘要

Purpose

Among Grade Group (GG) 5 prostate cancers (PCa), based on the Gleason grading system, those diagnosed preoperatively with Gleason score (GS) 5 + 4 have been reported to have poorer oncological prognoses compared to those with GS 4 + 5. However, the confounding effects of factors such as serum PSA level and clinical T stage remain unresolved. This study aimed to evaluate the impact of GS 5 + 4 versus 4 + 5 on postoperative prognosis, accounting for potential confounders.

Methods

This nationwide, multi-institutional retrospective cohort study included 827 patients who underwent robot-assisted radical prostatectomy (RARP) at 25 tertiary centers between 2011 and 2022. Patients were classified by preoperative biopsy as GS 4 + 5 (n = 671) or GS 5 + 4 (n = 156). Biochemical recurrence (BCR)-free survival was compared using inverse probability of treatment weighting (IPTW) and Cox regression, adjusting for age, BMI, PSA, clinical T stage, ASA physical status, and the use of extended lymph node dissection, nerve-sparing, and neoadjuvant hormone therapy.

Results

The median follow-up was 33.7 months. Adjusted 3- and 5-year BCR-free survival rates were 66.0% and 57.8% for GS 4 + 5, versus 54.8% and 44.6% for GS 5 + 4. GS 5 + 4 remained significantly associated with worse BCR-free survival compared to GS 4 + 5 (HR 1.41, 95% CI 1.04–1.89, p = 0.039).

Conclusion

Among GG 5 PCa, GS 5 + 4 was associated with significantly poorer BCR-free survival compared to GS 4 + 5, even after adjustment for key confounders. These findings support considering further risk refinement within GG 5.