title: The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens.
abstract: In the Gleason grading system for prostatic cancer only the two most prevalent patterns are reported, although a third (tertiary) pattern grade may be present. We compared the pathologic stage of 227 radical prostatectomies with tertiary pattern 5 to the pathologic stage of 604 radical prostatectomies lacking a tertiary component. Gleason score 3 + 4 tumors with a tertiary pattern of 5 were more likely to present with higher stage disease than those Gleason score 3 + 4 tumors without a tertiary component (P = 0.012) and at a stage similar to Gleason score 3 + 5 tumors. Gleason score 4 + 3 tumors with a tertiary pattern of 5 were less likely to be organ-confined than Gleason score 4 + 3 tumors (P = 0.02) and less likely to have lymph node metastases than Gleason score 4 + 4 tumors (P = 0.027). However, Gleason score 4 + 4 with a tertiary pattern of 5 were indistinguishable from Gleason score 4 + 4 tumors. The relative effects of a tertiary pattern of 5 were greatest when the primary and secondary stages were low but become obscured by the already aggressive nature of advanced primary and secondary patterns. Therefore, except for very high-grade tumors, tertiary scoring of prostatic adenocarcinoma at radical prostatectomy should be reported as it has prognostic significance.
authors.affiliation: Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Mosse
authors.forename: Cristina
authors.initials: C
authors.lastname: Magi-Galluzzi
authors.forename: Toyonori
authors.initials: T
authors.lastname: Tsuzuki
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008297:Male; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies