Significance of Gleason Score 7 With Tertiary Pattern 5 at Radical Prostatectomy

To study the prognostic influence of tertiary pattern 5 (TP5) in radical prostatectomy specimens with a Gleason score of 7.

A total of 4060 specimens with a Gleason score of 7 with and without TP5 seen between 2005 and 2015 were retrospectively reviewed. Cases were subdivided into 3 + 4 = 7, 3 + 4 = 7 with TP5, 4 + 3 = 7, and 4 + 3 = 7 with TP5. We compared prostate-specific antigen, clinical stage, pathologic stage, and surgical margin status between the groups. The impact of TP5 on biochemical recurrence was also assessed.

The median age was 68 years old with a median prostate-specific antigen level of 9.3 ng/mL. TP5 was present in 259 patients (6.4%) with a Gleason score 3 + 4 = 7 and in 361 patients (8.9%) with a Gleason score of 4 + 3 = 7. The mean follow-up without progression was 3 years. The presence of a tertiary pattern correlated with pathologic stage; the only exception was that there was no statistically significant difference between Gleason score 3 + 4 = 7 with TP5 and 4 + 3 = 7. Multivariate analysis showed that TP5 was independently associated with biochemical recurrence among patients with a Gleason score of 7 (P < .001). There was no difference between 3 + 4 = 7 with TP5 and 4 + 3 = 7 in terms of biochemical recurrence-free survival rate (P = .4).

The impact of TP5 of Gleason score 7 in radical prostatectomy specimens is still significant using contemporary grading. Moreover, TP5 was independently associated with biochemical recurrence. However, 3 + 4 = 7 with TP5 behaves like 4 + 3 = 7 in terms of biochemical recurrence-free survival rate.