The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

Abstract

ÖZETAmaç: Bu çalışmada amaç, radikal prostatektomi (RP) spesmenlerinde yüksek tersiyer patern bulunması-nın histopatolojik sonuçlar ve PSA progresyonu üzerine etkisini değerlendirmektir. Gereç ve yöntemler:Çalışmada kliniğimizde ocak 2007-ocak 2011 tarihleri arasında klinik lokalize prostat kanseri tanısı ile radikal prostatektomi operasyonu uygulanmış ve günümüze kadar takibe düzenli olarak gelmiş olan, gleason skoru 5-8 (5 ve 8 dahil) olan, 71 hastanın spesmenleri tek patolog tarafından tekrar incelenmiştir. Hastalar yüksek tersiyer gleason patern (gleason 4 veya 5) bulunması açısından değerlendi-rildi. Tersiyer paternin bulunmasının histopatolojik sonuçlar ve PSA progresyonu üzerine etkisi araştırıldı. Hastalar ilk iki yıl 3 ayda bir, sonraki 2 yıl 6 ayda 1, sonrasında yılda bir serbest ve total PSA ölçümü ve dijital rektal muayene yapılarak takip edildi. PSA progresyonu serum total PSA değerinin 0.2 ng/mL ve ABSTRACT Objective: The aim of this study was to analyze the effect of a high-grade tertiary pattern in radical prostatectomy (RP) specimens on the histopathological results and PSA progression. Material and methods:In this study, specimens from 71 patients with clinically localized prostate cancer who underwent RP between January 2007 and January 2011 in our department, who regularly attended their follow-up visits and who had a Gleason score of 5-8 (5 and 8 included) were reanalyzed by a single pathologist. The patients were evaluated for the presence of a high-grade tertiary Gleason pattern (Gleason 4 or 5). We investigated the effect of the tertiary pattern on the histopathological results and PSA progression. The patients were followed with testing for the free and total levels of PSA and given a digital rectal examination quarterly for the first two years, semiannually for the next 2 years, and annually for the remaining period. An increase in the serum total PSA count of 0.2 ng/mL or more was considered to represent PSA progression. The statistical analysis in this study was performed with SPSS for Windows Version 15.0 (Inc., Chicago, IL). p<0.05 was accepted as significant. Results:The incidence of a high-grade tertiary pattern in RP specimens was found to be 15.4%. The patients were categorized into groups that were positive or negative for a tertiary pattern. When compared with the other group, the tertiary pattern positive group had higher preoperative PSA levels (p= 0.469), more frequent extracapsular extension (p= 0.031), more frequent lymph node (p= 0.05) and seminal vesicle invasion (p= 0.022) and more advanced disease in terms of the pathological stage (p= 0.005). The patients were followed up for an average of 36,3 months postoperatively. PSA recurrence was found to be significantly higher in the tertiary pattern positive group (p= 0.001), and the PSA progression time was shorter (p= 0.001). There was no statistically significant difference between the two groups in terms of preoperative age, clinical stage, Gleason score and surgical margin positivity. When we investigated the effects o...