Presence of high grade tertiary Gleason pattern upgrades the Gleason sum score and is inversely associated with biochemical recurrence-free survival

Türker, Polat; Bas, Emine; Bozkurt, Süheyla; Günlüsoy, Bülent; Sezgin, Arsenal; Postacı, Hakan; Türkeri, Levent

doi:10.1016/j.urolonc.2010.10.009

Cited by 38 publications

(33 citation statements)

References 21 publications

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“…Since the 2005 ISUP convention, others have substantiated the prognostic significance of a tertiary Gleason pattern [8,11–14,27–29], with rare exception [7]. However, only few of these studies focused on GS6 (or GS<7) patients, and each grouped tertiary patterns 4 and 5 together in all analyses [11,13,14,29].…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of prospectively assigned Gleason tertiary pattern 4 in contemporary Gleason score 3+3=6 prostate cancer

et al. 2016

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OBJECTIVE To determine the oncologic impact of prospectively assigned tertiary pattern 4 in contemporary Gleason score (GS) 3 +3 =6 radical prostatectomy (RP) specimens. PATIENTS AND METHODS Oncologic outcomes were retrospectively reviewed for 720 consecutive patients from a single National Comprehensive Cancer Network (NCCN) center with at least 6 months follow-up after RP for GS3 +3 =6 (GS6, N =222), GS6 with tertiary pattern 4 (GS6t4, N =62), or GS3 +4 =7 (N =436) prostate cancer, as prospectively graded since 2006 using the 2005 International Society of Urologic Pathologists criteria. Preoperative NCCN risk category, RP pathology, progression-free survival (PFS) and metastasis-free survival (MFS) were compared among the GS6, GS6t4, and GS3 +4 =7 groups using χ2, Kaplan–Meier, and log-rank analyses. RESULTS The incidence of low NCCN preoperative risk classification for GS6t4 patients (63%) was less than that for GS6 patients (77%) while greater than that for GS3 +4 =7 patients (30%, P <0.001). GS6t4 patients had RP pathologic features which were intermediate in risk between that of GS6 and GS3 +4 =7 based on extraprostatic extension (27% vs. 6% vs. 31%, respectively, P <0.001) and mean percentage of prostate gland involvement (13% vs. 10% vs. 16%, respectively, P <0.001). With a mean overall follow-up of 42 months, PFS for GS6t4 patients (5-year 85%) was intermediate between that of GS6 (5-year 93%) and GS3 +4 =7 (5-year 76%) patients (P <0.001). The 5-year MFS rate was 100% for GS6 and GS6t4 patients compared to 97% for GS3 +4 =7 patients (P =0.07). CONCLUSIONS This study provides the longest follow-up to date for RP patients with prospectively assigned GS6t4 and supports a risk for adverse RP pathology and postoperative disease progression that is intermediate between GS6 and GS3 +4 =7. Whether a tertiary pattern 4 in GS6 disease increases the risk of metastasis is uncertain and requires longer term study. Given favorable oncologic outcomes, less stringent postoperative surveillance for both GS6 and GS6t4 patients may be warranted.

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Section: Discussionmentioning

confidence: 99%

Clinical significance of prospectively assigned Gleason tertiary pattern 4 in contemporary Gleason score 3+3=6 prostate cancer

et al. 2016

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“…Within this context, we wanted to evaluate whether targeted MR-GB substantially decreases the risk of Gleason upgrading on final pathology as compared to the current gold standard. Because the occurrence of a Gleason patterns 4/5 is of prognostic importance (Turker et al 2013;Servoll et al 2012), we did not restrict our analysis to the cGS, but also included the analysis of the hGP.…”

Section: Discussionmentioning

confidence: 99%

The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy

Arsov

Becker

Robert

et al. 2015

J Cancer Res Clin Oncol

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“…However, that review only included one study published after the ISUP Consensus Conference on Gleason grading and the metaanalysis failed to take into account the variable definitions of the tertiary Gleason pattern. More recent studies such as those by Turker et al [15], Trock et al [16], Pierorazio et al [23], and Servoll et al [24] concluded that high-grade TP is important as an independent predictor of PSA recurrence in Gleason 7 and 8 prostate cancers. In fact, Nanda et al [25] found the risk of PSA recurrence in patients with Gleason 7 disease with TP5 to be similar to patients with Gleason 9 or 10 diseases.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Impact of tertiary Gleason pattern 5 on prostate cancer aggressiveness: lessons from a contemporary single institution radical prostatectomy series

Koloff¹,

Hamstra²,

Wei³

et al. 2014

Asian Journal of Urology

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Objective: To better evaluate tertiary Gleason pattern reporting and to evaluate the impact of tertiary Gleason pattern 5 (TP5) on prostate cancer pathological features and biochemical recurrence at our large single institution. Methods: We retrospectively reviewed 1962 patients who underwent radical prostatectomy (RP) for prostate cancer; TP5 was reported in 159 cases (8.1%). Men with Gleason score (GS) 7 and GS 8 disease were divided into subgroups with and without TP5, and histopathological features were compared. Multivariate analyses were conducted to assess the impact on TP5 on biochemical-free survival (BFS). Results: Tumors possessing GS 3 þ 4 with TP5 were more likely to exhibit extraprostatic extension (EPE) and had a larger tumor diameter (TD) than GS 3 þ 4 alone. GS 3 þ 4 with TP5 was also associated with positive surgical margins (SM), seminal vesicle involvement (SVI), and higher pre-operative prostate-specific antigen (PSA) values, but without statistical significance. GS 4 þ 3 with TP5 more commonly presented with EPE, positive SM, SVI, and greater TD and pre-operative PSA level than GS 4 þ 3 alone. In multivariate analysis, Gleason score, EPE, and TP5 were overall independent risk factors for PSA recurrence in this cohort. Additionally, GS 4 þ 3 with TP5 was associated with shorter time to recurrence versus GS 4 þ 3 alone. Conclusion: Our results emphasize the importance of TP5 and suggest that criteria for tertiary

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Presence of high grade tertiary Gleason pattern upgrades the Gleason sum score and is inversely associated with biochemical recurrence-free survival

Cited by 38 publications

References 21 publications

Clinical significance of prospectively assigned Gleason tertiary pattern 4 in contemporary Gleason score 3+3=6 prostate cancer

Clinical significance of prospectively assigned Gleason tertiary pattern 4 in contemporary Gleason score 3+3=6 prostate cancer

The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy

WITHDRAWN: Impact of tertiary Gleason pattern 5 on prostate cancer aggressiveness: lessons from a contemporary single institution radical prostatectomy series

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