Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens.

Published

Journal Article

PURPOSE: The Gleason grading system in reporting prostate cancer accounts for the primary and secondary Gleason pattern. The clinical significance of a higher tertiary (third most prevalent) grade is largely unrecognized. MATERIALS AND METHODS: Radical prostatectomy specimens from 300 patients with Gleason score 7 (3 + 4 or 4 + 3) prostate cancer were pathologically reexamined for the presence of a tertiary grade 5 pattern as well as the association with pathological stage and biochemical recurrence-free survival. RESULTS: A total of 214 patients met study inclusion criteria. Patients with Gleason score 7 and tertiary grade 5 cancer had significantly higher pathological stage disease than patients with Gleason score 7 without tertiary grade 5 cancer (p <0.001). Gleason score 7 + tertiary pattern 5 tumors were significantly associated with adverse pathological features such as seminal vesicle invasion, extraprostatic extension and lymphovascular invasion compared to Gleason score 7 tumors (p <0.05). The relative effects of a tertiary grade 5 component on all pathological parameters analyzed was greater for Gleason score 7 tumors with a lower primary Gleason pattern 3 vs a higher primary Gleason pattern 4. Patients with Gleason score 7 + tertiary pattern 5 tumors had significantly decreased biochemical recurrence-free survival (54 months) compared to patients with Gleason score 7 tumors (121 months) (p = 0.0005). Preoperative prostate specific antigen, lymphovascular invasion and positive surgical margin status were shown to be independent predictors of prostate specific antigen recurrence on multivariate analysis. CONCLUSIONS: Small percentages of tertiary grade 5 patterns in Gleason score 7 radical prostatectomy specimens are associated with aggressive pathological features predictive of advanced pathological stage and biochemical recurrence-free survival.

Full Text

Duke Authors

Cited Authors

  • Whittemore, DE; Hick, EJ; Carter, MR; Moul, JW; Miranda-Sousa, AJ; Sexton, WJ

Published Date

  • February 2008

Published In

Volume / Issue

  • 179 / 2

Start / End Page

  • 516 - 522

PubMed ID

  • 18076949

Pubmed Central ID

  • 18076949

Electronic International Standard Serial Number (EISSN)

  • 1527-3792

Digital Object Identifier (DOI)

  • 10.1016/j.juro.2007.09.085

Language

  • eng

Conference Location

  • United States