{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:10:38Z","timestamp":1778656238501,"version":"3.51.4"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100018722","name":"Jaap Schouten Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018722","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Virchows Arch"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Current guidelines recommend pathologists to report percentage Gleason pattern 4 (GP4%) in Gleason score (GS) 7 prostate cancer (PCa) biopsies. However, it is unspecified whether the highest or overall GP4% should be reported. This study aims to clarify which quantification method correlates best with radical prostatectomy (RP) pathology. This study included 308 men with the highest GS 3\u2009+\u20094\u2009=\u20097, 4\u2009+\u20093\u2009=\u20097, or 4\u2009+\u20094\u2009=\u20098 on centrally revised systematic and\/or targeted biopsies who underwent RP between 2018 and 2022. The highest and overall biopsy GP4% were compared with RP GP4% using Spearman\u2019s rank correlation coefficient and adverse pathology (AP) (pT-stage\u2009\u2265\u2009T3, GS\u2009\u2265\u20094\u2009+\u20093\u2009=\u20097 and\/or pN1) using multivariable logistic regression models adjusted for clinical tumor stage, prostate specific antigen (PSA), percentage of tumor positive biopsies, biopsy modality (systematic\/targeted\/both), and cribriform pattern. Both quantification methods correlated with RP GP4% (both rho\u2009=\u20090.59), and no significant difference was found between them (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.78). On multivariable analyses, both GP4% quantification methods were significantly associated with AP (per 10% increase, highest GP4% odds ratio [OR] 1.26 [95% CI 1.14\u20131.39], overall GP4% OR 1.38 [95% CI 1.22\u20131.58], both\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). The area under the curve (AUC) was slightly better for overall (0.78 [95% CI 0.73\u20130.83]) than the highest GP4% (0.76 [95% CI 0.71\u20130.81],\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.041). This study found that the highest and overall biopsy GP4% both correlated with RP GP4%. Although the discriminative performance of the highest and overall GP4% was comparable with respect to AP at RP, the overall GP4% statistically slightly outperformed the highest GP4%. Including the overall GP4% may have added value in risk stratification and clinical decision-making in a subset of PCa patients.\n                  <\/jats:p>","DOI":"10.1007\/s00428-025-04117-2","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T23:32:07Z","timestamp":1749166327000},"page":"811-818","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of highest and overall percentage Gleason pattern 4 in prostate cancer biopsies"],"prefix":"10.1007","volume":"488","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6801-3633","authenticated-orcid":false,"given":"L. 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The Jaap Schouten Foundation was not involved in the study contents of any kind and also does not have a conflict of interest regarding study contents or results. RCNB reports the following: advisory board (Astellas, Janssen), speaker (Amgen, Astellas, Ipsen, Janssen, MSD), travel grants (Astellas, Bayer), research support (Astellas, Janssen). The other authors have no funding or conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}