title: Gleason score 7 prostate cancer: a heterogeneous entity? Correlation with pathologic parameters and disease-free survival.
abstract: OBJECTIVE
  Gleason score 7, in different proportions of grades 3 and 4, is the score most frequently assigned to prostate cancer in our radical prostatectomy specimens (RPSs). We correlated the major grade component of score 7 tumors with clinicopathologic parameters and disease-free survival.
  
  
  METHODS
  All Gleason score 7 RPSs were classified as having a major grade of 3 or 4 carcinoma. The two groups were compared according to patient age, race, serum prostate-specific antigen (PSA) level, clinical and pathologic stage, tumor volume, and biochemical recurrence.
  
  
  RESULTS
  Of the 534 patients analyzed, 356 and 178 had major grade 3 or 4 tumors, respectively. Compared with patients with 3+4 tumors, those with 4+3 had significantly more advanced clinical and pathologic stages, larger tumor volume, higher preoperative PSA levels, and older age and a higher proportion were African American (P <0.05 for all above parameters). With a mean follow-up of 34.6 months, patients with 3+4 tumors experienced lower rates of PSA recurrence than did those with 4+3 tumors (P = 0.0021). Furthermore, for the subset of patients with organ-confined disease, multivariable analysis that included race, age, clinical stage, preoperative PSA level, tumor volume, and major grade component found only the latter to be a significant predictor of recurrence, with patients who had major grade 4 component tumors experiencing a higher incidence of PSA recurrence than those with major grade 3 tumors (P = 0.012).
  
  
  CONCLUSIONS
  The major grade 4 component in Gleason score 7 carcinoma indicates a higher likelihood of biochemical recurrence, particularly for the increasing proportion of patients with organ-confined disease after radical prostatectomy.
authors.affiliation: Department of Pathology, Harper Hospital, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Sakr
authors.forename: M V
authors.initials: MV
authors.lastname: Tefilli
authors.forename: D J
authors.initials: DJ
authors.lastname: Grignon
authors.forename: M
authors.initials: M
authors.lastname: Banerjee
authors.forename: J
authors.initials: J
authors.lastname: Dey
authors.forename: E L
authors.initials: EL
authors.lastname: Gheiler
authors.forename: R
authors.initials: R
authors.lastname: Tiguert
authors.forename: I J
authors.initials: IJ
authors.lastname: Powell
authors.forename: D P
authors.initials: DP
authors.lastname: Wood
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000145:classification / Q000473:pathology*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery*