
The study compared Gleason Grade Group (GGG) classifications through central and local pathology reviews, assessing overall and worst GGG's impact on patient outcomes in prostate cancer treated with radiotherapy and hormone therapy. Central pathology-derived GGG showed better stratification of outcomes than local pathology. GGG 3 behaved similarly to GGG 4 in outcomes. Patient upgrades from GGG 2-3 using worst GS correlated with GGG 3 on long-term follow-up. Both overall and worst GS should be used for GGG derivation.
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