title: [Existence of pattern 5 on radical prostatectomy: poor prognostic factor associated with a lower biochemical recurrence-free survival].
abstract: OBJECTIVE
  To analyze the impact of the existence of Gleason grade 5 on the adverse pathology and biochemical recurrence-free survival of patients.
  
  
  METHODS
  Three hundred and seventy-two prostatectomies were performed between 1999 and 2011 in our institution for localised prostate adenocarcinoma. We examined the existence of grade 5 of the specimen to determine the reliability of prostate biopsies in the diagnosis of grade 5 and the association of grade 5 with other histoprognostic factors. Biochemical recurrence-free survival was analyzed according to the presence of grade 5 in the final specimen.
  
  
  RESULTS
  In total, all histological data and biochemical recurrence-free survival were available for 321 patients who were included in the study. Sixty-eight had Gleason grade 5 (majority or third minority pattern) on the specimen while 253 had not. Grade 5, rarely diagnosed on biopsy (sensitivity=26.47 %) was correlated independently with the extracapsular extension (OR=2.1; CI 95 [1.1-3.9]), the seminal vesicle invasion (OR=3.8; CI 95 [1.7-8.7]) and positive surgical margins (OR=2.0; CI 95 [1.1-3.6]). Overall survival was similar in both groups but the biochemical recurrence-free survival was statistically lower in the presence of grade 5 (HR=3.7; CI 95 [1.8-7.6]). Biochemical recurrence-free survival was not different than grade 5 is predominant or third minority pattern (HR=1.01; CI 95 [0.3-2.8]). On multivariate analysis, grade 5 was an independent risk factor for biochemical recurrence (P=0.005) as well as seminal vesicle invasion (P=0.047).
  
  
  CONCLUSIONS
  The existence of grade 5 in the surgical specimen whatever the percentage was a poor prognostic factor associated with increased tumor aggressiveness and reduced biochemical recurrence-free survival.
  
  
  METHODS
  5.
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25003 Besançon, France; Université de Franche-Comté, 25000 Besançon, France.
authors.forename: J
authors.initials: J
authors.lastname: Pastori
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25003 Besançon, France; Université de Franche-Comté, 25000 Besançon, France.
authors.forename: L
authors.initials: L
authors.lastname: Balssa
authors.affiliation: Service d'urologie, CHI de Haute-Saône, 25000 Vesoul, France.
authors.forename: J
authors.initials: J
authors.lastname: Lillaz
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25003 Besançon, France.
authors.forename: G
authors.initials: G
authors.lastname: Guichard
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25003 Besançon, France.
authors.forename: E
authors.initials: E
authors.lastname: Chabannes
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25003 Besançon, France.
authors.forename: S
authors.initials: S
authors.lastname: Bernardini
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25003 Besançon, France; Université de Franche-Comté, 25000 Besançon, France.
authors.forename: H
authors.initials: H
authors.lastname: Bittard
authors.affiliation: Université de Franche-Comté, 25000 Besançon, France; Service d'oncologie médicale, CHRU de Besançon, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Thiery-Vuillemin
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25003 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France. Electronic address: francois.kleinclauss@univ-fcomte.fr.
authors.forename: F
authors.initials: F
authors.lastname: Kleinclauss
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D012669:Seminal Vesicles / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen
keywords: Adverse pathological factors; Cancer de prostate; Gleason pattern 5; Grade de Gleason 5; Oncological outcomes; Prostate cancer; Prostatectomie totale; Radical prostatectomy; Survie