The highest percentage of Gleason Pattern 4 is a predictor in intermediate-risk prostate cancer

This study aims to clarify the clinicopathological significance of several novel pathological markers, including the percentage of Gleason pattern 4 and small/non-small cribriform pattern, in intermediate-risk Gleason score 3 + 4 = 7 prostate cancer.

Two-hundred and twenty-eight patients with Gleason score 3 + 4 = 7 intermediate-risk prostate cancer who underwent radical prostatectomy between 2009 and 2019 at our institute were selected. Preoperative clinicopathological characteristics, including serum prostate-specific antigen level, clinical T stage, percentage of cancer-positive cores at biopsy, small/non-small cribriform pattern, the highest percentage of Gleason pattern 4, the total length of Gleason pattern 4 and percentage of Gleason score 7 cores were examined in univariate/multivariate logistic regression analysis to determine their predictive value for postoperative adverse pathological findings, defined as an upgrade to Gleason score 4 + 3 = 7 or higher, pN1 or pT3b disease.

Fifty-four cases (23.7%) showed adverse pathological findings. Although a non-small cribriform pattern, highest Gleason pattern 4 percentage and total length of Gleason pattern 4 were predictive of adverse pathological findings in univariate analysis, only the highest Gleason pattern 4 percentage was an independent predictive factor in multivariate analysis (odds ratio: 1.610; 95% confidence interval: 1.260-2.070; P = 0.0002).

The highest Gleason pattern 4 percentage was a potent predictive parameter for Gleason score 3 + 4 = 7 intermediate-risk prostate cancer and should be considered in the risk classification scheme for prostate cancer.