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The prognostic role of tertiary Gleason pattern 5 in a contemporary grading system for prostate cancer

 W S Jang  ;  C Y Yoon  ;  M S Kim  ;  D H Kang  ;  Y J Kang  ;  W S Jeong  ;  M J Abalajon  ;  W S Ham  ;  Y D Choi 
 Prostate Cancer and Prostatic Diseases, Vol.20(1) : 93-98, 2017 
Journal Title
 Prostate Cancer and Prostatic Diseases 
Issue Date
Aged ; Combined Modality Therapy ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Prostatic Neoplasms/mortality* ; Prostatic Neoplasms/pathology* ; Prostatic Neoplasms/therapy ; Recurrence ; Retrospective Studies ; Tumor Burden
BACKGROUND: Recently, a new prostate cancer (PC) grading system has been introduced, where Gleason score (GS) 7 (3+4) and GS 7 (4+3) are categorized into two separate groups. However, GS 7 with tertiary Gleason pattern 5 (TGP5) was not incorporated in the new grading system. In the present study, we validated the prognostic role of TGP5 in the new classification. METHODS: We retrospectively reviewed the records of 1396 patients with localized GS 6-8 PC (pT2-3N0M0) who underwent radical prostatectomy at our institution between 2005 and 2014. After excluding patients who received neoadjuvant or adjuvant therapy, or had incomplete pathological or follow-up data, 1229 patients were included in the final analysis. The Kaplan-Meier method was used to estimate and compare the probabilities of biochemical recurrence (BCR). Cox regression models were used to investigate associations between variables and the risk of BCR. RESULTS: Of 732 GS 7 patients, 75 (10.2%) had a TGP5. The BCR-free survival rate for men with TGP5 was significantly worse than for those without TGP5 (P<0.001). In multivariate Cox regression analyses for GS 7 PC, TGP5 was a significant predictor of BCR (hazard ratio 1.750, P=0.027). When the total cohort was stratified into four grade groups according to the new classification, group 2 with TGP5 had a BCR risk comparable to group 3, and group 3 with TGP5 behaved like group 4. CONCLUSIONS: Our study shows that TGP5 increased the BCR risk after RP in GS 7 PC. Moreover, we demonstrated that the presence of a TGP5 in GS 7 upgraded the BCR risk to one comparable with the next higher category under the new classification. These findings support incorporating TGP5 into GS 7 to aid with future risk assessment and follow-up scheduling for PC.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
강동혁(Kang, Dong Hyuk)
강용진(Kang, Yong Jin)
김명수(Kim, Myung Soo)
윤철용(Yoon, Cheol Yong)
장원식(Jang, Won Sik) ORCID logo https://orcid.org/0000-0002-9082-0381
정원식(Jeong, Won Sik)
최영득(Choi, Young Deuk) ORCID logo https://orcid.org/0000-0002-8545-5797
함원식(Ham, Won Sik) ORCID logo https://orcid.org/0000-0003-2246-8838
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