Percentage of Gleason pattern 4 and 5 predicts survival after radical prostatectomy

Abstract

BACKGROUND.Morphologic and clinical heterogeneity within tumor grades is well recognized in prostate cancer. The objective of the current study was to determine whether the combined percentage of Gleason patterns 4 and 5 in radical prostatectomy specimens is an independent predictor of cancer‐specific survival in prostate cancer patients.METHODS.The radical prostatectomy specimens were analyzed from 504 consecutive prostate cancer patients who were treated at Indiana University Medical Center between 1990 and 1998. Various clinical and pathologic characteristics were analyzed.RESULTS.A higher combined percentage of Gleason patterns 4 and 5 was associated with older age, higher preoperative serum prostate‐specific antigen level, higher pathologic stage, positive surgical margins, extraprostatic extension of tumor, higher Gleason score, perineural invasion, and lymph node metastasis. In the multivariate Cox regression model, the combined percentage of Gleason patterns 4 and 5 was found to be an independent predictor of cancer‐specific survival (P = .04).CONCLUSIONS.The combined percentage of Gleason patterns 4 and 5 is a powerful predictor of prostate cancer‐specific survival. Assessment of high‐grade cancer amounts may allow for better stratification of patients into appropriate prognostic groups and treatment protocols. Cancer 2007. © 2007 American Cancer Society.

Current Perspectives on Gleason Grading of Prostate Cancer

“…Glands that have poorly formed lumina were considered as grade 4, although the vote on this did not reach consensus (29 yes, 11 no). Third, it was agreed that in individual needle cores, secondary or tertiary grades constituting less than 5% of the area that are lower than the primary grade should be ignored, but evidence [14,15] supports that those that are higher than the primary grade should be reflected in the Gleason score. Finally, in radical prostatectomy specimens, there was no consensus whether the score should include higher grades comprising less than 5% of tumor area.…”

“…The presence of any pattern 4 as a secondary grade [13] or even a tertiary grade [14] now is sufficient to label a cancer as high grade overall. Not only does the proportion of pattern 4+5 independently predict outcome [15,16], but 4+3 = 7 (score 7b) in biopsy cores had a distinctly worse outcome than 3 + 4 = 7 (score 7a) [17], and correlated with finding high-grade (score 8-10) tumor at prostatectomy [18]. In prostatectomy specimens, grade 7b predicted a threefold higher rate of lethal cancer when present in prostatectomy specimens [17], although the difference with grade 7a has not been significant in all studies [3].…”

The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part B: Prostate and Bladder Tumours

“…An abundance of data suggests that percentage of adenocarcinoma that is high-grade pattern 4/5 is an important prognostic indicator [29][30][31]. The method for determination of percentage of pattern 4 was not specified.…”

Prostat Kanser Patolojisi

“…Tümörü oluşturan yüksek dereceli (Gleason patern 4 veya 5) prostat kanserinin yüzde-si önemli bir prognostik göstergedir [27,28] [29,30].…”