title: Oncologic outcomes of patients with Gleason score 7 and tertiary Gleason pattern 5 after radical prostatectomy.
abstract: OBJECTIVE
  We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5).
  
  
  METHODS
  We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were classified into four groups: GS 6, GS 7 without TGP5, GS 7 with TGP5, and GS 8. We analyzed preoperative clinical factors, postoperative pathological outcomes, and biochemical recurrence (BCR).
  
  
  RESULTS
  TGP5 in GS 7 was an independent predictor of primary Gleason pattern 4, tumor volume larger than 10%, positive surgical margin, and lymphovascular invasion. The presence of TGP5 in GS 7 was not associated with BCR-free survival. Subgroup analyses revealed that BCR-free survival did not differ significantly between patients with GS 7 with TGP5 and those with GS 8 (p=0.120). In addition, time to BCR in patients with a higher percentage of TGP5 was shorter than that in patients with a lower percentage of TGP5. TGP5 in GS 7 was not a significant predictive factor for BCR, whereas prostate-specific antigen density and a positive surgical margin were shown to be independent predictors of BCR.
  
  
  CONCLUSIONS
  TGP5 in GS 7 was an independent predictor of unfavorable pathologic outcomes. The rate of BCR was similar in GS 7 disease with TGP5 and in GS 8 disease, even though TGP5 was not a significant predictive factor for BCR in Cox proportional hazards models.
authors.affiliation: Department of Urology, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Yi-Hsueh
authors.initials: YH
authors.lastname: Leng
authors.forename: Won Jun
authors.initials: WJ
authors.lastname: Lee
authors.forename: Seung Ok
authors.initials: SO
authors.lastname: Yang
authors.forename: Jeong Ki
authors.initials: JK
authors.lastname: Lee
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Jung
authors.forename: Yun Beom
authors.initials: YB
authors.lastname: Kim
keywords: Disease progression; Neoplasm grading; Prostatectomy
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