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

Borhan, Walaa; Epstein, Jonathan I.

doi:10.1016/j.urology.2016.10.035

Cited by 13 publications

(28 citation statements)

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“…Patients in GG2‐3 with tertiary Gleason 5 patterns had an increase in absolute risk of treatment failure of >20% at 6 years as compared to patients in the same group without tertiary Gleason pattern; the relative risk increase was 50% to 100%. In line with our findings, patients with Gleason 7 tumours in several other cohorts had a significantly worse prognosis if they had tertiary Gleason 5 pattern . In a retrospective study, 75 patients in GG2 and GG3 who had tertiary Gleason 5 pattern had similar biochemical recurrence rates to those in GG3 and GG4 without a tertiary pattern, respectively .…”

Section: Discussionsupporting

confidence: 89%

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Optimization of the 2014 Gleason grade grouping in a Canadian cohort of patients with localized prostate cancer

et al. 2018

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Section: Discussionsupporting

confidence: 89%

“…Similarly, Sim et al. and Borhan and Epstein concluded that patients with Gleason 3 + 4 tumours with tertiary Gleason 5 pattern had recurrence rates similar to patients with Gleason 4 + 3 tumours. Although Boras et al.…”

Section: Discussionmentioning

confidence: 84%

Optimization of the 2014 Gleason grade grouping in a Canadian cohort of patients with localized prostate cancer

et al. 2018

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“…2,24 According to the 2014 ISUP consensus conference, 5,25 pattern 5 in Gleason 3 + 4 and Gleason 4 + 3 prostatectomy specimens can be considered as a tertiary pattern when it occupies <5% of tumor volume. 26,27 Because the current study was a multi-institutional, retrospective study, we did not have a centralized or specialized read for pathology reports. 25 Therefore, a tertiary pattern could have accounted for cases with GrGp5 on biopsy yet GrGp2 or GrGp3 at the time of RP.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the presence of tertiary pattern 5 in the RP specimen in conjunction with GrGp2 and GrGp3 could prognostically be associated with oncological outcomes almost equivalent to the next highest GrGp. 26,27 Because the current study was a multi-institutional, retrospective study, we did not have a centralized or specialized read for pathology reports. The interobserver variability among pathologists who evaluate the prostate specimens is an inherent limitation of multi-institutional cohorts.…”

Section: Discussionmentioning

confidence: 99%

Influence of African American race on the association between preoperative biopsy grade group and adverse histopathologic features of radical prostatectomy

Aminsharifi

Schulman

Howard

et al. 2019

Cancer

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BACKGROUND:The current study was performed to evaluate the influence of race on the association between biopsy grade group (GrGp) and the risk of detectable prostate-specific antigen (PSA) and adverse histopathological outcomes after radical prostatectomy (RP). METHODS: Data regarding 4073 men (1344 African American men; 33%) who were treated with RP were categorized based on the 5-tiered GrGp system. Logistic regression was used to test the association between biopsy GrGp and PSA nadir (<0.1 ng/mL) after RP as well as adverse pathological features among all patients and stratified by race. RESULTS: Those patients with a higher biopsy GrGp were found to have lower odds of achieving a PSA nadir <0.1 ng/mL after RP on unadjusted and multivariable analysis (both P < .001). On unadjusted and multivariable analysis, higher GrGp was associated with increased odds of each of the adverse pathological features, namely, GrGp ≥3, extraprostatic extension, seminal vesicle invasion, positive surgical resection margin, and positive lymph nodes (all P < .001). Race had no significant interaction with biopsy GrGp in the prediction of PSA nadir after RP (P = .91) or any adverse pathological features (all P > .06) except positive lymph nodes. When the models were stratified by race, the associations between preoperative biopsy GrGp and having a PSA nadir <0.1 ng/mL, high-grade final pathology, or other adverse histopathologic features were similar in both races except as noted for positive lymph nodes. CONCLUSIONS: Higher preoperative biopsy GrGp is associated with increased odds of adverse histopathological findings as well as lower odds of a PSA nadir <0.1 ng/mL after RP. These associations are largely independent of race, suggesting that GrGp is an accurate tool for risk stratification in both black and white men. Cancer 2019;125:3025-3032.

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“…[1][2][3][4][5] While most of so-called tertiary grading reported in the literature refers to a higher grade-typically pattern 5-the term has been used variably regarding extent, ranging from a more limited, minor, or less than 5% highergrade carcinoma component in initial publications 3,4 to a third most common pattern of any percentage. [6][7][8][9][10][11][12][13][14][15][16][17][18] The accepted method for reporting ''tertiary'' patterns also differs between needle biopsy and radical prostatectomy (RP). As codified by the International Society of Urologic Pathology (ISUP) 2005 and 2014 grading conferences, cases with 3 patterns on needle biopsy should be graded by using a ''first plus worst'' (most common þ next highest grade) strategy.…”

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confidence: 99%

Practice Patterns in Reporting Tertiary Grades at Radical Prostatectomy: Survey of a Large Group of Experienced Urologic Pathologists

Fine

Meisels

Al‐Ahmadie

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— In prostate cancer, “tertiary” higher-grade patterns (TPs) have been associated with biochemical recurrence after radical prostatectomy. Objective.— To determine variation regarding definition and application of TPs. Design.— Online survey regarding TPs in a range of grading scenarios circulated to 105 experienced urologic pathologists. Results.— Among 95 respondents, 40 of 95 (42%) defined TPs as “third most common pattern” and 55 (58%) as “minor pattern/less than 5% of tumor.” In a tumor with pattern 3 and less than 5% pattern 4, of the 95 respondents, 35 (37%) assigned 3 + 3 = 6 with TP4, while 56 (59%) assigned 3 + 4 = 7. In a tumor with pattern 4 and less than 5% pattern 5, of the 95 respondents, 51 (54%) assigned 4 + 4 = 8 with TP5, while 43 (45%) assigned 4 + 5 = 9. Six scenarios were presented in which the order of most common patterns was 3, 4, and 5 (Group 1) or 4, 3, and 5 (Group 2) with varying percentages. In both groups, when pattern 5 was less than 5%, we found that 98% and 93% of respondents would assign 3 + 4 = 7 or 4 + 3 = 7 with TP5. In scenarios with 15% or 25% pattern 5, most respondents (70% and 80%, respectively) would include pattern 5 as the secondary grade, that is, 3 + 5 = 8 (Group 1) or 4 + 5 = 9 (Group 2). For 85 of 95 (89%), a TP would not impact Grade Group assignment. Conclusions.— This survey highlights substantial variation in practice patterns regarding definition and application of “tertiary” grading in radical prostatectomy specimens. High consistency was observed in 3 + 4 = 7/4 + 3 = 7 scenarios with truly minor pattern 5. These findings should inform future studies assessing the standardization and predictive value of “tertiary” patterns.

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

Cited by 13 publications

References 20 publications

Optimization of the 2014 Gleason grade grouping in a Canadian cohort of patients with localized prostate cancer

Optimization of the 2014 Gleason grade grouping in a Canadian cohort of patients with localized prostate cancer

Influence of African American race on the association between preoperative biopsy grade group and adverse histopathologic features of radical prostatectomy

Practice Patterns in Reporting Tertiary Grades at Radical Prostatectomy: Survey of a Large Group of Experienced Urologic Pathologists

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