title: Prevalence of a tertiary Gleason grade and its impact on adverse histopathologic parameters in a contemporary radical prostatectomy series.
abstract: 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.
authors: Martini-Clinic, Prostate Cancer Centre, Hamburg-Eppendorf, Germany. h.isbarn@uke.uni-hamburg.de
authors: Hendrik
authors: H
authors: Isbarn
authors: Sascha A
authors: SA
authors: Ahyai
authors: Felix K H
authors: FK
authors: Chun
authors: Lars
authors: L
authors: Budäus
authors: Thorsten
authors: T
authors: Schlomm
authors: Georg
authors: G
authors: Salomon
authors: Mario
authors: M
authors: Zacharias
authors: Andreas
authors: A
authors: Erbersdobler
authors: Jens
authors: J
authors: Köllermann
authors: Guido
authors: G
authors: Sauter
authors: Hartwig
authors: H
authors: Huland
authors: Markus
authors: M
authors: Graefen
authors: Thomas
authors: T
authors: Steuber
mesh_terms: 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