Primary Gleason pattern in biopsy Gleason score 7 is predictive of adverse histopathological features and biochemical failure following radical prostatectomy

Abstract

In biopsies with GS 7, a primary Gleason pattern 4 was associated with significantly elevated risk of adverse histopathological features and biochemical failure compared to pattern 3 in patients undergoing RP. This study underlines the heterogeneity of biopsy GS 7.

Global Transcriptome Analysis of Formalin-Fixed Prostate Cancer Specimens Identifies Biomarkers of Disease Recurrence

“…It has been suggested that primary Gleason 4 pattern and Gleason 3 pattern tumors represent different disease states (23), and several studies have supported the concept that the primary Gleason pattern of Gleason seven patients is predictive of outcome (4–6). To investigate the differences in gene expression, we performed DEseq differential gene expression analysis comparing 43 samples with Gleason 3+4 (primary pattern 3) to 22 samples with Gleason 4+3 (primary pattern 4).…”

“…Patients with a Gleason score of eight or higher generally have a poor prognosis, and those with Gleason scores of six or lower generally have favorable prognoses, but it is much more difficult to predict outcomes for the very large number of patients with a Gleason score of seven. Several studies have supported the concept that the Gleason 4+3 pattern tumors have worse outcomes than Gleason 3+4 tumors (4–6), but clinical parameters alone are not sufficient for accurate prediction of recurrence. Thus, biomarkers that can predict the likely clinical outcome and recurrence for patients after surgical therapy are urgently needed in order to aid clinicians in deciding on the appropriate course of treatment and in accurate prognostication for patients.…”

Heterogeneity of Outcomes in D'Amico Intermediate-Risk Prostate Cancer Patients after Radical Prostatectomy: Influence of Primary and Secondary Gleason Score

“…It has been well described that pathologic Gleason score 4 + 3 has worse outcomes in terms of disease-free survival and prostate cancer-specific mortality than Gleason 3 + 4 [5,6,[24][25][26][27][28]. However, the body of literature examining differences in outcomes based on primary biopsy Gleason pattern in Gleason 7 tumors is limited [29,30].…”

Accuracy of Grading Gleason Score 7 Prostatic Adenocarcinoma on Needle Biopsy: Influence of Percent Pattern 4 and Other Histological Factors

“…Gleason score 7 prostatic carcinomas are traditionally subdivided into 3 þ 4 ¼ 7 (Grade Group 2) and 4 þ 3 ¼ 7 (Grade Group 3), depending whether pattern 4 is predominant. Published studies have shown that the greater the amount of Gleason pattern 4, the worse the prognosis [7][8][9][10][11]. Multiple studies have examined the inter-observer reproducibility of Gleason grading of prostatic adenocarcinoma both amongst urologic pathologists as well as between general pathologists.…”