Korean J Urol.  2013 Sep;54(9):587-592.

Oncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy

• Leng YH
• Lee WJ
• Yang SO
• Lee JK
• Jung TY
• Kim YB

Abstract

PURPOSE
We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5).
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were classified into four groups: GS 6, GS 7 without TGP5, GS 7 with TGP5, and GS 8. We analyzed preoperative clinical factors, postoperative pathological outcomes, and biochemical recurrence (BCR).
RESULTS
TGP5 in GS 7 was an independent predictor of primary Gleason pattern 4, tumor volume larger than 10%, positive surgical margin, and lymphovascular invasion. The presence of TGP5 in GS 7 was not associated with BCR-free survival. Subgroup analyses revealed that BCR-free survival did not differ significantly between patients with GS 7 with TGP5 and those with GS 8 (p=0.120). In addition, time to BCR in patients with a higher percentage of TGP5 was shorter than that in patients with a lower percentage of TGP5. TGP5 in GS 7 was not a significant predictive factor for BCR, whereas prostate-specific antigen density and a positive surgical margin were shown to be independent predictors of BCR.
CONCLUSIONS
TGP5 in GS 7 was an independent predictor of unfavorable pathologic outcomes. The rate of BCR was similar in GS 7 disease with TGP5 and in GS 8 disease, even though TGP5 was not a significant predictive factor for BCR in Cox proportional hazards models.

Keyword

Disease progression; Neoplasm grading; Prostatectomy

MeSH Terms

Disease Progression
Humans
Medical Records
Neoplasm Grading
Proportional Hazards Models
Prostate-Specific Antigen
Prostatectomy
Recurrence
Retrospective Studies
Tumor Burden
Prostate-Specific Antigen

Figure

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  FIG. 1 Kaplan-Meier survival analysis of patients with GS 6 vs. GS 7 without TGP5, GS7 without TGP5 vs. GS 7 with TGP5, GS7 without TGP5 vs. GS 8, and GS 7 with TGP5 vs. GS 8. GS, Gleason score; TGP5, tertiary Gleason pattern 5; BCR, biochemical recurrence; RP, radical prostatectomy.

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  FIG. 2 Kaplan-Meier survival analysis of patients with GS 7 with <5% vs. ≥5% TGP5. GS, Gleason score; TGP5, tertiary Gleason pattern 5; BCR, biochemical recurrence; RP, radical prostatectomy.

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