Significance of Tertiary Gleason Pattern 5 in Gleason Score 7 Radical Prostatectomy Specimens

Whittemore, Darren E.; Hick, Eric J.; Carter, Mark R.; Moul, Judd W.; Miranda-Sousa, Alejandro J.; Sexton, Wade J.

doi:10.1016/j.juro.2007.09.085

Cited by 73 publications

(62 citation statements)

References 21 publications

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“…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. In contrast to those studies, others found that tertiary Gleason patterns were not consistently independent predictors of PSA recurrence [8,11].…”

Section: Discussionmentioning

confidence: 69%

WITHDRAWN: Impact of tertiary Gleason pattern 5 on prostate cancer aggressiveness: lessons from a contemporary single institution radical prostatectomy series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

confidence: 69%

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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“…In addition, we assessed the presence of tertiary Gleason grade 5 and intraductal carcinoma of the prostate in each specimen as both have been associated with adverse clinical outcome. [13][14][15][16][17] The following Gleason grade 4 growth patterns, as defined by the ISUP-modified Gleason grading scheme, 2 were scored: (1) fused glands included fused well-and poorly formed glands ( Figure 1a). (2) Ill-defined glands comprised glands with poorly formed or absent glandular lumina (Figure 1b).…”

Section: Pathologic Evaluationmentioning

confidence: 99%

Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

et al. 2015

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Patients with Gleason score 7 prostate cancer on radical prostatectomy demonstrate a wide range in clinical outcome. Gleason grade 4 prostate cancer encompasses a heterogeneous group of tumor growth patterns including fused, ill-defined, cribriform, and glomeruloid glandular structures. Our objective was to determine the prognostic value of different Gleason grade 4 growth patterns. We performed a nested case-control study among 535 patients with Gleason score 7 prostate cancer at radical prostatectomy, treated between March 1985 and July 2013 at a university hospital in the Netherlands. We analyzed 52 cases (with metastasis, diseasespecific mortality or both) and 109 controls, matched for age, PSA level, and pT stage. Presence of the following Gleason grade 4 patterns was recorded: fused, ill-defined, cribriform, and glomeruloid. Intraductal carcinoma of the prostate and tertiary Gleason grade 5 were additionally assessed. Outcomes were metastasis-free survival and disease-specific survival. We used Cox proportional hazards regression to determine the predictive value of Gleason grade 4 patterns for survival time. The overall prevalence of Gleason grade 4 patterns was as follows: fused 75% (n ¼ 121), ill-defined 64% (n ¼ 102), cribriform 48% (n ¼ 83), and glomeruloid 25% (n ¼ 40). Cribriform pattern was the only pattern with an unequal distribution between cases and controls. Forty-two out of 52 cases (81%) had cribriform growth pattern versus 41/109 controls (38%). In multivariate analysis, presence of cribriform growth was an adverse independent predictor for distant metastasis-free survival (HR 8.0, 95% CI 3.0-21; Po0.001) and disease-specific survival (HR 5.4, 95% CI 2.0-15, P ¼ 0.001). In conclusion, cribriform growth in Gleason grade 4 is a strong prognostic marker for distant metastasis and disease-specific death in patients with Gleason score 7 prostate cancer at radical prostatectomy.

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“…GS 7 cancer with tertiary pattern 5 has significantly moreaggressive behavior than pure GS 7 PC. [21][22][23][24][25] For this reason, we matched LN þ cases for an equivalent number of LN À cases with tertiary pattern 5. Higher-grade tumor was more prevalent at radical prostatectomy in Henry Ford Hospital compared with The Johns Hopkins Hospital.…”

Section: Commentmentioning

confidence: 99%

Gleason Score 7 Adenocarcinoma of the Prostate With Lymph Node Metastases: Analysis of 184 Radical Prostatectomy Specimens

Kryvenko

Gupta

Virani

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Prostate cancer (PC) with lymph node metastases (LN þ ) is relatively rare, whereas it is relatively common in disease with a Gleason score (GS) 8 to 10 and virtually never seen in PC with GS 6 or less. It is most variable in GS 7 PC.Objective.-To determine clinicopathologic features associated with GS 7 PC with LN þ compared with a control group without lymph node metastases (LN À ). Design.-We analyzed 184 GS 7 radical prostatectomies with LN þ and the same number of LN À Gleasonmatched controls. The LN þ cases were GS 3 þ 4 ¼ 7 (n ¼ 64; 34.8%), GS 4 þ 3 ¼ 7 (n ¼ 66; 35.9%), GS 3 þ 4 ¼ 7 with tertiary 5 (n ¼ 10; 5.4%), and GS 4 þ 3 ¼ 7 with tertiary 5 (n ¼ 44; 23.9%).Results.-The LN þ cases demonstrated higher average values in preoperative prostate-specific antigen (12.2 versus 8.1 ng/mL), percentage of positive biopsy cores (59.1% versus 42.9%), prostate weight (54.4 versus 49.4 g), number of LNs submitted (12.7 versus 9.4), incidence of nonfocal extraprostatic extension (82.6% versus 63.6%), tumor volume (28.9% versus 14.8%), frequency of lymphovascular invasion (78.3% versus 38.6%), intraductal spread of carcinoma (42.4% versus 20.7%), incidence of satellite tumor foci (16.4% versus 4.3%), incidence of pT3b disease (49.5% versus 14.7%), and lymphovascular invasion in the seminal vesicles (52% versus 30%). There were differences in GS 4 patterns and cytology between LN þ and LN À cases, with the former having higher volumes of cribriform and poorly formed patterns, larger nuclei and nucleoli, and more-frequent macronucleoli. All P .05.Conclusion.-Gleason score 7 PC with LN þ has features highlighting a more-aggressive phenotype. These features can be assessed as prognostic markers in GS 7 disease on biopsy (eg, GS 4 pattern, intraductal spread, cytology) or at radical prostatectomies (all variables), even in men without LN dissection or LN À disease.

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Significance of Tertiary Gleason Pattern 5 in Gleason Score 7 Radical Prostatectomy Specimens

Abstract: 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.

Cited by 73 publications

References 21 publications

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

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

Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

Gleason Score 7 Adenocarcinoma of the Prostate With Lymph Node Metastases: Analysis of 184 Radical Prostatectomy Specimens

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