title: A tertiary Gleason pattern in the prostatectomy specimen and its association with adverse outcome after radical prostatectomy.
abstract: OBJECTIVE
  The prognostic significance of a tertiary Gleason pattern in the radical prostatectomy specimen is controversial. We tested the impact of a tertiary Gleason pattern on adverse histopathological features and biochemical recurrence rates after radical prostatectomy.
  
  
  METHODS
  We assessed data on 11,226 consecutive patients treated with radical prostatectomy at our institution between June 2007 and February 2013. We compared 2,396 patients with (22.4%) and 8,260 without (77.5%) a tertiary Gleason pattern for adverse histopathological features (extraprostatic extension, seminal vesicle invasion, positive surgical margins and lymph node invasion) using the chi-square test. The effect of a tertiary Gleason pattern on biochemical recurrence was tested in univariable and multivariable models. Subanalyses were then done for different radical prostatectomy Gleason groups (6 or less, 3 + 4 and 4 + 3).
  
  
  RESULTS
  A tertiary Gleason pattern was statistically significantly associated with all evaluated histopathological parameters (each p <0.001). It was an independent predictor of biochemical recurrence (HR 1.43, p <0.001). On subanalysis only a tertiary Gleason pattern independently predicted biochemical recurrence in the patient cohort with a radical prostatectomy Gleason score of 3 + 4 and 4 + 3. However, it failed to attain independent predictor status in patients with a radical prostatectomy Gleason score of 6 or less.
  
  
  CONCLUSIONS
  A tertiary Gleason pattern is a significant and independent predictor of biochemical recurrence after radical prostatectomy with the strongest prognostic effect in cases with Gleason scores 3 + 4 and 4 + 3. Therefore, a tertiary Gleason pattern should be recorded in the pathological report.
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: meikeadam@hotmail.com.
authors: Meike
authors: M
authors: Adam
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Amir
authors: A
authors: Hannah
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Lars
authors: L
authors: Budäus
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Thomas
authors: T
authors: Steuber
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Georg
authors: G
authors: Salomon
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Uwe
authors: U
authors: Michl
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Alexander
authors: A
authors: Haese
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Margit
authors: M
authors: Fisch
authors: Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Corinna
authors: C
authors: Wittmer
authors: Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Stefan
authors: S
authors: Steurer
authors: Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Sarah
authors: S
authors: Minner
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Hans
authors: H
authors: Heinzer
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Hartwig
authors: H
authors: Huland
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Markus
authors: M
authors: Graefen
authors: Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Guido
authors: G
authors: Sauter
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Thorsten
authors: T
authors: Schlomm
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Hendrik
authors: H
authors: Isbarn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies
keywords: local; neoplasm grading; neoplasm recurrence; prostate; prostatectomy; prostatic neoplasms