Men with Gleason score (GS) 4+3 prostate cancer (PCa) have a 3-fold greater risk of distant metastasis at diagnosis than men with GS 3+4 PCa, according to a new study.

Mohamed H. Kamel, MD, of the University of Arkansas for Medical Sciences in Little Rock, and colleagues retrospectively reviewed 1402 medical records of men presenting to 5 Veterans Affairs hospitals with GS 7 PCa. The cohort consisted of 1050 men with GS 3+4 and 352 with GS 4+3 disease.

The 2 groups were similar with respect to sociodemographic and clinical characteristics. The mean ages of the GS 3+4 and GS 4+3 groups were 63.6 and 65.4 years, respectively. The racial composition was 49.5% white and 49.4% black in the GS 3+4 group and 45% white and 53% black in the GS 4+3 group.

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A significantly higher proportion of patients in GS 4+3 group than the GS 3+4 group had distant metastases at diagnosis (2.8% vs 0.9%), the investigators reported in Urology Annals (2018;10:203-208). In addition, the study found that average PSA levels were significantly higher in the GS 4+3 group than the GS 3+4 group (18 vs 11.4 ng/mL). Dr Kamel’s team found no statistically significant difference in overall survival.

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The study was limited by its retrospective, non-randomized approach to the review of medical information, the authors noted.


Kamel MH, Khalil MI, Alobuia WM, et al. Incidence of metastasis and prostate-specific antigen levels at diagnosis in Gleason 3+4 versus 4+3 prostate cancer. Urol Ann. 2018;10:203-208.