Introduction

In 2015, Prognostic Grade Groups (PGG) 1 through 5 were introduced to reclassify Gleason pathology reporting. We studied the performance of the Prognostic Grade Groups (PGG) in the Shared Equal Access Regional Cancer Hospital (SEARCH) database for predicting perioperative oncologic outcomes within a multiracial equal access healthcare system.

Methods

We reviewed records of men who underwent radical prostatectomy at one of six Veterans Affairs hospitals between 1988 and 2015. 4,200 men with available data were included. The predictive utility of biopsy PGG for multiple perioperative clinical endpoints was examined using logistic regression models. Interactions between PGG and race were tested.

Results

The cohort consisted of PGG 1 through 5, respectively: 1,989(47%), 1,142(27%), 515(12%), 402(10%), 152(4%). 1,569(38%) were African American(AA). Higher biopsy PGG was associated with higher stage, older age, higher preoperative PSA and more positive biopsy cores (p≤0.012). Higher PGG was associated with higher risk of extracapsular extension(ECE), seminal vesicle invasion(SVI), positive surgical margins(PSM) and lymph node involvement(LNI) and lower likelihood of achieving PSA nadir <0.01 after surgery (all p<0.001). Lower PGG was more likely to be upgraded at surgery (p=<0.001). [Table 1 outlines risks associated with each PGG group.] AA men had decreased risk of upgrading (p=0.001). None of the other endpoints varied by race(p>0.1).

Conclusions

Prostate Prognostic Grade Groups predicted multiple perioperative oncologic endpoints after prostatectomy in a large, multiracial cohort of men. In this cohort, African American men had lower rates of pathologic upgrading at surgery.

Funding

none