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

Asian Journal of Urology, 2015, 2 (1): 53-58 doi:

Original Article

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

Zachary B. Koloff¹, Daniel A. Hamstra², John T. Wei¹, Jeffrey S. Montgomery¹, Scott A. Tomlins³, Angela J. Wu³, Todd M. Morgan¹, Javed Siddiqui¹, Kellie Paich¹, Arul M. Chinnaiyan³, Felix Y. Feng³, Alon Z. Weizer¹, Lakshmi P. Kunju³, Brent K. Hollenbeck¹, David C. Miller¹, Ganesh S. Palapattu¹, Rohit Mehra³

1. Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA;
2. Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA;
3. Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA

Abstract
Related Citation (15)

Download:

HTML

PDF (671KB)
Export: BibTeX | EndNote (RIS)

Abstract 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+4 with TP5 were more likely to exhibit extraprostatic extension (EPE) and had a larger tumor diameter (TD) than GS 3+4 alone. GS 3+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+3 with TP5 more commonly presented with EPE, positive SM, SVI, and greater TD and pre-operative PSA level than GS 4+3 alone. In multivariate analysis, Gleason score, EPE, and TP5 were overall independent risk factors for PSA recurrence in this cohort. Additionally, GS 4+3 with TP5 was associated with shorter time to recurrence versus GS 4+3 alone. Conclusion: Our results emphasize the importance of TP5 and suggest that criteria for tertiary pattern reporting in prostate cancer should be standardized. Further studies are needed to evaluate the role of tertiary patterns in prognostic models.

Key words： Tertiary Gleason pattern Prostate cancer Prostatic neoplasm Gleason score Radical prostatectomy Disease-free survival

Received: 18 July 2014 Published: 06 February 2015

Fund:R.M. and A.M.C. are supported by the Prostate Cancer Foundation.

Corresponding Authors: Rohit Mehra E-mail: mrohit@med.umich.edu

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Zachary B. Koloff
	Daniel A. Hamstra
	John T. Wei
	Jeffrey S. Montgomery
	Scott A. Tomlins
	Angela J. Wu
	Todd M. Morgan
	Javed Siddiqui
	Kellie Paich
	Arul M. Chinnaiyan
	Felix Y. Feng
	Alon Z. Weizer
	Lakshmi P. Kunju
	Brent K. Hollenbeck
	David C. Miller
	Ganesh S. Palapattu
	Rohit Mehra

TRENDMD:

Cite this article:

Zachary B. Koloff,Daniel A. Hamstra,John T. Wei, et al. Impact of tertiary Gleason pattern 5 on prostate cancer aggressiveness: Lessons from a contemporary single institution radical prostatectomy series[J]. Asian Journal of Urology, 2015, 2(1): 53-58.

URL:

http://www.ajurology.com/EN/ OR http://www.ajurology.com/EN/Y2015/V2/I1/53

[1]	Chan TY, Partin AW, Walsh PC, Epstein JI. Prognostic significance of Gleason score 3+4 versus Gleason score 4+3 tumor at radical prostatectomy. Urology 2000;56:823-7.
[2]	Herman CM, Kattan MW, Ohori M, Scardino PT, Wheeler TM. Primary Gleason pattern as a predictor of disease progression in Gleason score 7 prostate cancer: a multivariate analysis of 823 men treated with radical prostatectomy. Am J Surg Pathol 2001;25:657-60.
[3]	Hoedemaeker RF, Rietbergen JB, Kranse R, Schroder FH, van der Kwast TH. Histopathological prostate cancer characteristics at radical prostatectomy after population based screening. J Urol 2000;164:411-5.
[4]	Epstein JI, Partin AW, Sauvageot J, Walsh PC. Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. Am J Surg Pathol 1996;20:286-92.
[5]	Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. J Am Med Assoc 1997;277:1445-51.
[6]	Epstein JI. An update of the Gleason grading system. J Urol 2010;183:433-40.
[7]	Gleason DF. Histological grading and clinical staging of prostatic carcinoma. Philadelphia: Lea & Feibiger; 1977. p. 171-98.
[8]	Hashine K, Yuasa A, Shinomori K, Shirato A, Ninomiya I, Teramoto N. Tertiary Gleason pattern 5 and oncological outcomes after radical prostatectomy. Jan J Clin Oncol 2011;41: 571-6.
[9]	Rasiah KK, Stricker PD, Haynes AM, Delprado W, Turner JJ, Golovsky D, et al. Prognostic significance of Gleason pattern in patients with Gleason score 7 prostate carcinoma. Cancer 2003;98:2560-5.
[10]	Sim HG, Telesca D, Culp SH, Ellis WJ, Lange PH, True LD, et al. Tertiary Gleason pattern 5 in Gleason 7 prostate cancer predicts pathological stage and biochemical recurrence. J Urol 2008;179:1775-9.
[11]	Whittemore DE, Hick EJ, Carter MR, Moul JW, Miranda-Sousa AJ, Sexton WJ. Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens. J Urol 2008;179:516-22.
[12]	Mosse CA, Magi-Galluzzi C, Tsuzuki T, Epstein JI. The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol 2004;28:394-8.
[13]	Pan CC, Potter SR, Partin AW, Epstein JI. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol 2000;24:563-9.
[14]	Epstein JI, Allsbrook Jr WC, Amin MB, Egevad LL, Committee IG. The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005;29:1228-42.
[15]	Turker P, Bas E, Bozkurt S, Günlüsoy B, Sezgin A, Postac? H, et al. Presence of high grade tertiary Gleason pattern upgrades the Gleason sum score and is inversely associated with biochemical recurrence-free survival. Urol Oncol 2013;31:93-8.
[16]	Trock BJ, Guo CC, Gonzalgo ML, Magheli A, Loeb S, Epstein JI. Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system. J Urol 2009;182:1364-70.
[17]	Harnden P, Shelley MD, Coles B, Staffurth J, Mason MD. Should the Gleason grading system for prostate cancer be modified to account for high-grade tertiary components? A systematic review and meta-analysis. Lancet Oncol 2007;8:411-9.
[18]	McNeal JE, Bostwick DG, Kindrachuk RA, Redwine EA, Freiha FS, Stamey TA. Patterns of progression in prostate cancer. Lancet 1986;1:60-3.
[19]	McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA. Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate. Cancer 1990;66:1225-33.
[20]	Cheng L, Koch MO, Juliar BE, Daggy JK, Foster RS, Bihrle R, et al. The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy. J Clin Oncol 2005;23:2911-7.
[21]	Stamey TA, McNeal JE, Yemoto CM, Sigal BM, Johnstone IM. Biological determinants of cancer progression in men with prostate cancer. J Am Med Assoc 1999;281:1395-400.
[22]	Jackson W, Hamstra DA, Johnson S, Zhou J, Foster B, Foster C, et al. Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer-specific death in patients receiving salvage radiation therapy following radical prostatectomy. Cancer 2013;119:3287-94.
[23]	Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013;111:753-60.
[24]	Servoll E, Saeter T, Vlatkovic L, Lund T, Nesland J, Waaler G, et al. Impact of a tertiary Gleason pattern 4 or 5 on clinical failure and mortality after radical prostatectomy for clinically localised prostate cancer. BJU Int 2012;109:1489-94.
[25]	Nanda A, Chen MH, Renshaw AA, D'Amico AV. Gleason pattern 5 prostate cancer: further stratification of patients with highrisk disease and implications for future randomized trials. Int J Radiat Oncol Biol Phys 2009;74:1419-23.
[26]	Di Blasio CJ, Rhee AC, Cho D, Scardino PT, Kattan MW. Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol 2003;30:567-86.