{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:52:12Z","timestamp":1775897532264,"version":"3.50.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"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","award":["2024008"],"award-info":[{"award-number":["2024008"]}],"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"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Quantification of biopsy Gleason pattern (GP) 4 contributes to risk assessment and supports clinical decision-making in Grade Group 2 (GG2) prostate cancer (PCa) patients. The optimal methodology for assessment of GP4 quantity is yet unclear. The objective of this study is to compare the mutual relation and performance of biopsy GP4 quantification methods to predict biochemical recurrence-free survival (BCRFS) after radical prostatectomy (RP). Ninety-four patients with biopsy GG2 PCa who underwent RP were included. We recorded overall GP4 percentage and cumulative GP4 length (mm) across all cores, as well as the maximum percentage and length within a single core. Quantification methods were compared using Spearman\u2019s rank correlation and Cox proportional hazard regression for BCRFS. All biopsy GP4 quantification methods were mutually correlated (rho coefficients varying from 0.655 to 0.935;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001), while correlation with GP4 percentage at RP was weak to moderate (rho coefficient range 0.260 to 0.326;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.02). All biopsy GP4 quantification methods significantly predicted post-operative BCRFS. Absolute GP4 measures had better discriminative performance than percentages (cumulative GP4 length Hazard Ratio [HR] 1.14; 95% Confidence Interval [95% CI] 1.07\u20131.22;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001; c-index 0.711; overall GP4 percentage HR 1.05; 95% 1.01\u20131.09;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.007; c-index 0.635). Adding GP3 percentage or length did not have added value (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&gt;\u20090.5) for predicting BCRFS once absolute GP4 length was known. Absolute GP4 length (mm) in biopsy GG2 PCa patients has better predictive value for post-operative BCRFS than GP4 percentage. GP3 volume does not add to prediction once GP4 volume is known.\n                  <\/jats:p>","DOI":"10.1007\/s00428-026-04515-0","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:01:14Z","timestamp":1775894474000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of biopsy gleason pattern 4 percentage and length in grade group 2 prostate cancer patients"],"prefix":"10.1007","author":[{"given":"Yosamin M. Gonzalez","family":"Belisario","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Hollemans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geert J. L. H.","family":"van Leenders","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,11]]},"reference":[{"key":"4515_CR1","doi-asserted-by":"crossref","unstructured":"Sauter G, Steurer S, Clauditz TS, Krech T, Wittmer C, Lutz F, Lennartz M, Janssen T, Hakimi N, Simon R, von Petersdorff-Campen M, Jacobsen F, von Loga K, Wilczak W, Minner S, Tsourlakis MC, Chirico V, Haese A, Heinzer H, Beyer B, Graefen M, Michl U, Salomon G, Steuber T, Budaus LH, Hekeler E, Malsy-Mink J, Kutzera S, Fraune C, Gobel C, Huland H, Schlomm T (2016) Clinical utility of quantitative gleason grading in prostate biopsies and prostatectomy specimens. Eur Urol 69:592\u2013598.","DOI":"10.1016\/j.eururo.2015.10.029"},{"key":"4515_CR2","doi-asserted-by":"publisher","first-page":"2182","DOI":"10.1200\/JCO.2015.65.7759","volume":"34","author":"RC Chen","year":"2016","unstructured":"Chen RC, Rumble RB, Loblaw DA, Finelli A, Ehdaie B, Cooperberg MR, Morgan SC, Tyldesley S, Haluschak JJ, Tan W, Justman S, Jain S (2016) Active surveillance for the management of localized prostate cancer (Cancer Care Ontario guideline): American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol 34:2182\u20132190. https:\/\/doi.org\/10.1200\/JCO.2015.65.7759","journal-title":"J Clin Oncol"},{"key":"4515_CR3","doi-asserted-by":"publisher","first-page":"461","DOI":"10.5858\/arpa.2020-0015-RA","volume":"145","author":"JI Epstein","year":"2021","unstructured":"Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K (2021) The 2019 Genitourinary Pathology Society (GUPS) white paper on contemporary grading of prostate cancer. Arch Pathol Lab Med 145:461\u2013493","journal-title":"Arch Pathol Lab Med"},{"key":"4515_CR4","doi-asserted-by":"crossref","DOI":"10.1097\/PAS.0000000000001497","volume":"44","author":"G van Leenders","year":"2020","unstructured":"van Leenders G, van der Kwast TH, Grignon DJ, Evans AJ, Kristiansen G, Kweldam CF, Litjens G, McKenney JK, Melamed J, Mottet N, Paner GP, Samaratunga H, Schoots IG, Simko JP, Tsuzuki T, Varma M, Warren AY, Wheeler TM, Williamson SR, Iczkowski KA, Members IGWP (2020) The 2019 International Society of Urological Pathology (ISUP) consensus conference on grading of prostatic carcinoma. Am J Surg Pathol 44:e87-e99","journal-title":"Am J Surg Pathol"},{"key":"4515_CR5","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.juro.2018.07.062","volume":"201","author":"LW Dean","year":"2019","unstructured":"Dean LW, Assel M, Sjoberg DD, Vickers AJ, Al-Ahmadie HA, Chen YB, Gopalan A, Sirintrapun SJ, Tickoo SK, Eastham JA, Scardino PT, Reuter VE, Ehdaie B, Fine SW (2019) Clinical usefulness of total length of gleason pattern 4 on biopsy in men with grade group 2 prostate cancer. J Urol 201:77\u201382","journal-title":"J Urol"},{"key":"4515_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2024.102204","volume":"22","author":"M Perera","year":"2024","unstructured":"Perera M, Assel M, Nalavenkata S, Khaleel S, Benfante N, Carlsson SV, Reuter VE, Laudone VP, Scardino PT, Touijer KA, Eastham JA, Vickers AJ, Fine SW, Ehdaie B (2024) Quantification of gleason pattern 4 metrics identifies pathologic progression in patients with grade group 2 prostate cancer on active surveillance. Clin Genitourin Cancer 22:102204","journal-title":"Clin Genitourin Cancer"},{"key":"4515_CR7","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1097\/PAS.0000000000000530","volume":"40","author":"JI Epstein","year":"2016","unstructured":"Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, Grading C (2016) The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. 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Eur Urol 86:1\u20133","journal-title":"Eur Urol"},{"key":"4515_CR12","doi-asserted-by":"publisher","DOI":"10.1111\/his.70052","author":"LJ Kroon","year":"2025","unstructured":"Kroon LJ, Remmers S, de V II, Kweldam CF, Rijstenberg LL, van den Bergh RCN, Roobol MJ, van Leenders G (2025) Rethinking Gleason pattern quantification in predicting metastasis: results of 20\u2009years of follow-up in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer. Histopathology. https:\/\/doi.org\/10.1111\/his.70052","journal-title":"Histopathology"},{"key":"4515_CR13","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.pathol.2021.11.004","volume":"54","author":"B Delahunt","year":"2022","unstructured":"Delahunt B, Steigler A, Atkinson C, Christie D, Duchesne G, Egevad L, Joseph D, Kenwright DN, Matthews J, Murray JD, Oldmeadow C, Samaratunga H, Spry NA, Thunders MC, Hondermarck H, Denham JW (2022) Percentage grade 4 tumour predicts outcome for prostate adenocarcinoma in needle biopsies from patients with advanced disease: 10-year data from the TROG 03.04 RADAR trial. 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Am J Surg Pathol 40:1686\u20131692","journal-title":"Am J Surg Pathol"}],"container-title":["Virchows Archiv"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00428-026-04515-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00428-026-04515-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00428-026-04515-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:01:15Z","timestamp":1775894475000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00428-026-04515-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,11]]},"references-count":17,"alternative-id":["4515"],"URL":"https:\/\/doi.org\/10.1007\/s00428-026-04515-0","relation":{},"ISSN":["0945-6317","1432-2307"],"issn-type":[{"value":"0945-6317","type":"print"},{"value":"1432-2307","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,11]]},"assertion":[{"value":"12 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 April 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The athors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}