title: Tertiary Gleason pattern 5 and oncological outcomes after radical prostatectomy.
abstract: OBJECTIVE
  This study examined the rate of Gleason pattern 5 and the influence of tertiary Gleason pattern 5 on oncological outcomes.
  
  
  METHODS
  Four hundred sixty-six patients underwent a radical prostatectomy between 1993 and 2008. Each surgical specimen was reviewed and assessed for the tumor diameter, Gleason score (which was based on the 2005 International Society of Urological Pathology Consensus Conference criteria) and the percentage of Gleason pattern 5.
  
  
  RESULTS
  The median patient age was 68.0 years old and the median prostate-specific antigen level was 9.28 ng/ml. A tertiary Gleason pattern 5 was present in 24.2% of patients with a Gleason score of <9; in 12.2% of patients with a Gleason score of 3 + 4 and in 45.9% of patients with a Gleason score of 4 + 3. A multivariate analysis showed that a tertiary Gleason pattern 5 was not independently associated with biochemical recurrence-free survival among patients in the Gleason score of 7 and 8 pN0 groups. One hundred eighty-seven patients had any rate of Gleason pattern 5 and significantly worse pathological factors, compared with patients who did not have this pattern. A multivariate analysis of all patients showed that the surgical margin, Gleason score, prostate-specific antigen level and pathological stage were all independent predictors of biochemical recurrence. However, the rate of Gleason pattern 5 was not an independent factor.
  
  
  CONCLUSIONS
  Tertiary Gleason pattern 5 was not a significant predictive factor for biochemical recurrence. The rate of Gleason pattern 5 was associated with adverse pathological factors.
authors.affiliation: Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama 791-0280, Japan. khashine@shikoku-cc.go.jp
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hashine
authors.forename: Akihito
authors.initials: A
authors.lastname: Yuasa
authors.forename: Kensuke
authors.initials: K
authors.lastname: Shinomori
authors.forename: Akitomi
authors.initials: A
authors.lastname: Shirato
authors.forename: Iku
authors.initials: I
authors.lastname: Ninomiya
authors.forename: Norihiro
authors.initials: N
authors.lastname: Teramoto
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen