title: The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy.
abstract: OBJECTIVE
  Clinical outcome is variable in prostate cancer patients treated with radical prostatectomy. The Gleason histologic grade of prostatic adenocarcinoma is one of the strongest predictors of biologic aggressiveness of prostate cancer. We evaluated the significance of the relative proportion of high-grade cancer (Gleason patterns 4 and/or 5) in predicting cancer progression in prostate cancer patients treated with radical prostatectomy.
  
  
  METHODS
  Radical prostatectomy specimens from 364 consecutive prostate cancer patients were totally embedded and whole mounted. Various clinical and pathologic characteristics were analyzed. All pathologic data, including Gleason grading variables, were collected prospectively.
  
  
  RESULTS
  A multiple-factor analysis was performed that included the combined percentage of Gleason patterns 4 and 5, Gleason score, tumor stage, surgical margin status, preoperative prostate-specific antigen (PSA), extraprostatic extension, and total tumor volume. Using Cox regression analysis with bootstrap resampling for predictor selection, we identified the combined percentage of Gleason patterns 4 and 5 (P < .0001) and total tumor volume (P = .009) as significant predictors of PSA recurrence.
  
  
  CONCLUSIONS
  The combined percentage of Gleason patterns 4 and 5 is one of the most powerful predictors of patient outcome, and appears superior to conventional Gleason score in identifying patients at increased risk of disease progression. On the basis of our results, we recommend that the combined percentage of Gleason patterns 4 and 5 be evaluated in radical prostatectomy specimens. The amount of high-grade cancer in a prostatectomy specimen should be taken into account in therapeutic decision making and assessment of patient prognosis.
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University Medical Center, University Hospital 3465, 550 N University Blvd, Indianapolis, IN 46202, USA. lcheng@iupui.edu
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: Michael O
authors.initials: MO
authors.lastname: Koch
authors.forename: Beth E
authors.initials: BE
authors.lastname: Juliar
authors.forename: Joanne K
authors.initials: JK
authors.lastname: Daggy
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gardner
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome