title: [Well differentiated localized prostate carcinoma: prognostic relevance of tertiary Gleason pattern 4 and tumor volume].
abstract: BACKGROUND
  Early introduction of adjuvant radiation or hormone therapy after radical prostatectomy has been advocated in recent literature aiming to improve survival rates in high risk prostate cancer. Traditional prognostic parameters such as serum PSA, Gleason score and clinical stage have been used to identify these cases however accuracy is far from ideal. Recently, tumor volume and presence and percentage of a tertiary less differentiated Gleason pattern have been considered better indicators of prostate cancer behavior. The purpose of this study was to evaluate the importance of presence and percentage of a Gleason pattern 4 and of tumor volume in the outcome of patients treated for well-differentiated prostate adenocarcinoma.
  
  
  METHODS
  Seventy seven patients submitted to radical prostatectomy for well-differentiated prostate carcinoma, Gleason score 6 or less, and followed up for at least 5 years were selected. Thirty seven experienced biochemical recurrence while 40 did not. The percentage of Gleason pattern 4, the percentage of the gland involvement (considered as "tumor volume"), capsular invasion and extraprostatic extension were submitted to univariate and multivariate analyses for the evaluation of possible associations with biochemical recurrence.
  
  
  RESULTS
  Tumor volume was the most important parameter to predict biochemical recurrence by univariate and multivariate analysis. The median of tumor volume was 25.0% for patients who suffered recurrence, and 11.5% for those with no recurrence (p=0.003). The percentage of Gleason pattern 4 was predictive of recurrence in univariate analysis only. The median percentage of Gleason pattern 4 was 7.5% for patients without recurrence and 19.0% for those who presented recurrence (p=0.046).
  
  
  CONCLUSIONS
  Tumor volume is very objective, easy to evaluate and the most important parameter to predict biochemical recurrence in well-differentiated adenocarcinoma of the prostate. On the other hand, presence and percentage of a tertiary less differentiated Gleason pattern correlated with systemic relapse. Both parameters should be included in future studies to evaluate the role of adjuvant therapy in high risk prostate cancer.
authors.affiliation: Laboratório de Patologia Cirúrgica e Molecular, Hospital Sírio Libanês, SP. katiaramos@uol.com.br
authors.forename: Katia R M
authors.initials: KR
authors.lastname: Leite
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Kauffmann
authors.forename: Ruy G
authors.initials: RG
authors.lastname: Bevilacqua
authors.forename: Adriano J
authors.initials: AJ
authors.lastname: Nesrallah
authors.forename: Luciano J
authors.initials: LJ
authors.lastname: Nesrallah
authors.forename: Luiz H
authors.initials: LH
authors.lastname: Camara-Lopes
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D047368:Tumor Burden
chemical_list: D017430:Prostate-Specific Antigen