Prevalence of a tertiary Gleason grade and its impact on adverse histopathologic parameters in a contemporary radical prostatectomy series.
BACKGROUND
The presence of a tertiary Gleason grade (TGG) pattern in radical prostatectomy (RP) specimens has been described as associated with adverse pathology and a higher biochemical recurrence (BCR) rate after RP.


OBJECTIVE
To assess the prevalence of a TGG in a contemporary, consecutive, single-centre RP series and its association with adverse pathology.


METHODS
From January to August 2007, 800 eligible patients (no prior neoadjuvant hormonal therapy) underwent RP for clinically localised prostate cancer (pCA) in our institution. The presence of the third most prevalent Gleason pattern was documented, regardless of whether it was better or worse than the two predominant Gleason grades.


METHODS
The overall prevalence of a TGG was described. Uni- and multivariate logistic regression analyses tested the association between the presence of a TGG <5% versus >or=5% of the whole tumour volume and extracapsular extension (ECE), seminal vesicle invasion (SVI), positive surgical margins (PSM), and lymph node invasion (LNI). Subanalyses were performed to assess the impact of different TGGs at various Gleason scores.


CONCLUSIONS
A TGG was reported in 180 RP specimens (22.5%). In univariate analysis, the presence of a TGG >/=5% was significantly associated with ECE, SVI, PSM, and LNI (p<0.001). In multivariate analysis, a TGG >or=5% showed an independent association with ECE and PSM (p<0.05). Accordingly, in subanalyses, a significant association with adverse pathology was only documented if the amount of a TGG was at least 5% of the tumour volume. Our study is limited by the relatively low overall frequency of a TGG, thereby reducing the statistical expressiveness, especially for subanalyses.


CONCLUSIONS
Our findings confirm the association of the presence of a TGG with adverse pathologic features. Further follow-up is needed to assess the prognostic impact of a TGG on the risk of BCR and overall survival following RP.
Isbarn
Hendrik
H
Martini-Clinic, Prostate Cancer Centre, Hamburg-Eppendorf, Germany. h.isbarn@uke.uni-hamburg.de
Ahyai
Sascha A
SA
Chun
Felix K H
FK
Budäus
Lars
L
Schlomm
Thorsten
T
Salomon
Georg
G
Zacharias
Mario
M
Erbersdobler
Andreas
A
Köllermann
Jens
J
Sauter
Guido
G
Huland
Hartwig
H
Graefen
Markus
M
Steuber
Thomas
T
D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000473:pathology; D016017:Odds Ratio; D015995:Prevalence; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D017741:Survivors