Evidence map›Paper›PMID 42000957›Full record

ArticleWorld journal of urology2026

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

Kimihiro Shimatani, Masashi Kubota, Shingo Yamamoto, Kei Mizuno, Takayuki Sumiyoshi, Ryoichi Saito, Masakatsu Ueda, Ryo Iguchi, Toshifumi Takahashi, Hitoshi Yokozeki and 9 more

Abstract readMulticenter Study
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In one paragraph

Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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0 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

19 authors.

Kimihiro ShimataniDepartment of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
Masashi KubotaDepartment of Urology, Kyoto University School of Medicine, Kyoto, Japan.
Shingo YamamotoDepartment of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
Kei MizunoDepartment of Urology, Kyoto University School of Medicine, Kyoto, Japan.
Takayuki SumiyoshiDepartment of Urology, Kyoto University School of Medicine, Kyoto, Japan.
Ryoichi SaitoDepartment of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
Masakatsu UedaDepartment of Urology, Shizuoka General Hospital, Shizuoka, Japan.
Ryo IguchiDepartment of Urology, Kurashiki Central Hospital, Okayama, Japan.
Toshifumi TakahashiDepartment of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
Hitoshi YokozekiDepartment of Urology, Toyooka Hospital, Hyogo, Japan.
Hiroshi IwamuraDepartment of Urology, Himeji Medical Center, Himeji, Hyogo, Japan.
Naoki KoheiDepartment of Urology, Numazu City Hospital, Shizuoka, Japan.
Ryoma KurahashiDepartment of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Yuya SekineDepartment of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Atsuro SawadaDepartment of Urology, Miyazaki University, Miyazaki, Japan.
Hiromitsu NegoroDepartment of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Shusuke AkamatsuDepartment of Urology, Nagoya University, Nagoya, Aichi, Japan.
Takashi KobayashiDepartment of Urology, Kyoto University School of Medicine, Kyoto, Japan. selecao@kuhp.kyoto-u.ac.jp.
Takayuki GotoDepartment of Urology, Kyoto University School of Medicine, Kyoto, Japan. goto@kuhp.kyoto-u.ac.jp.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAmong 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.

methodsThis 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.

resultsThe 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).

conclusionAmong 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.

Indexed as

ProstatectomyProstatic NeoplasmsRobotic Surgical ProceduresAgedBiopsyCohort StudiesHumansMaleMiddle AgedNeoplasm GradingPrognosisRetrospective StudiesTreatment OutcomeBiochemical recurrenceGleason grade groupGleason pattern 5Prostate cancer

Identifiers

PMID42000957

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.