Tertiary Gleason pattern in radical prostatectomy specimens is associated with worse outcomes than the next higher Gleason score group in localized prostate cancer

Özsoy, Mehmet; D’Andrea, David; Moschini, Marco; Foerster, Beat; Abufaraj, Mohammad; Mathiéu, Romain; Briganti, Alberto; Karakiewicz, Pierre I.; Rouprêt, Morgan; Seitz, Christian; Czech, Anna; Susani, Martin

doi:10.1016/j.urolonc.2017.12.003

Cited by 12 publications

(22 citation statements)

References 27 publications

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“…These patients had worse clinicopathological features than pure GG1 patients, and were more similar to GG2− patients. This finding is in line with those of others reporting on the clinical relevance of tertiary patterns, and underlines the importance of reporting them 44–53 …”

Section: Discussionmentioning

confidence: 99%

Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy

et al. 2020

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Aims: Invasive cribriform and intraductal carcinoma are associated with aggressive disease in Grade Group 2 (GG2) prostate cancer patients. However, the characteristics and clinical outcome of patients with GG2 prostate cancer without cribriform architecture (GG2À) as compared with those with Grade Group 1 (GG1) prostate cancer are unknown. The aim of this study was to investigate the clinical and pathological characteristics of GG1 and GG2À prostate cancer in radical prostatectomy specimens. Methods and results: We reviewed 835 radical prostatectomy specimens for Grade Group, pT stage, surgical margin status, and the presence of cribriform architecture. Biochemical recurrence-free survival and metastasis were used as clinical outcomes. GG1 prostate cancer was seen in 207 patients, and GG2 prostate cancer was seen in 420 patients, of whom 228 (54%) showed cribriform architecture (GG2+) and 192 (46%) did not. GG2À patients had higher prostate-specific antigen levels (9.4 ng/ml versus 7.0 ng/ml; P < 0.001), more often had extraprostatic extension (36% versus 11%; P < 0.001) and had more positive surgical margins (27% versus 17%; P = 0.01) than GG1 patients. GG2À patients had shorter biochemical recurrence-free survival (hazard ratio 2.7, 95% confidence interval 1.4-4.9; P = 0.002) than GG1 patients. Lymph node and distant metastasis were observed neither in GG2À nor in GG1 patients, but occurred in 22 of 228 (10%) GG2+ patients. Conclusion: In conclusion, patients with GG2À prostate cancer at radical prostatectomy have more advanced disease and shorter biochemical recurrencefree survival than those with GG1 prostate cancer, but both groups have a very low risk of developing metastasis.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy

et al. 2020

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“…Not surprisingly, other well‐established risk factors, such as Gleason score and positive surgical margin, were also significantly associated with BCR. In the literature, Gleason score is considered the most important prognostic factor of BCR and after RP tertiary Gleason pattern in the prostatectomy specimens is associated with worse outcomes than the next higher Gleason score group in localized prostate cancer . Many studies have shown that positive margin is an independent predictor of BCR while others had contradictory results …”

Section: Discussionmentioning

confidence: 99%

Ultrasensitive prostate‐specific antigen level as a predictor of biochemical progression after robot‐assisted radical prostatectomy: Towards risk adapted follow‐up

Grivas

Bruin²,

Barwari

et al. 2018

Clinical Laboratory Analysis

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Background Ultrasensitive prostate‐specific antigen (USPSA) is useful for stratifying patients according to their USPSA‐based risk. Aim of our study was to determine the usefulness of USPSA as predictor of biochemical recurrence (BCR) after robot‐assisted radical prostatectomy (RARP). Methods This retrospective study included 213 prostate cancer patients who had a postoperative USPSA between 0.01 and 0.2 ng/mL and at least 2 years of follow‐up. We developed predictive models for BCR with PSA ≥0.2 and ≥0.5 ng/mL. Results A total of 103 patients (48.3%) had BCR at a median follow‐up of 13.3 months. Higher postoperative USPSA (odds ratio [OR] = 4.73, P < 0.01), bilateral positive surgical margin in both sides (OR = 1.32, P = 0.044), higher average PSA rise (OR = 1.67, P = 0.031), ISUP grade group ≥3 (OR = 1.48, P = 0.003), and shorter interval since RARP (OR = 0.58, P < 0.001) were independent predictors of BCR with PSA ≥0.2 ng/mL. Higher postoperative USPSA (OR = 3.85, P < 0.01), bilateral positive surgical margin (OR = 1.34, P = 0.011), ISUP grade group ≥3 (OR = 1.5, P = 0.002), and shorter interval since RARP (OR = 0.61, P = 0.001) were independent predictors of BCR with PSA ≥0.5 ng/mL. The areas under the curve for the first and second model were 0.865 and 0.834, respectively. Conclusion Ultrasensitive PSA after RARP is a useful prognostic indicator of BCR which could guide postoperative risk stratification and layout follow‐up scheduling.

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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%

“…21,22 For RP specimens bearing 3 grading patterns, since the pathologist may assess the entire tumor, the ''tertiary'' terminology has been recommended. 19 The latter recommendation is based on an array of studies 3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18] showing that cancers with a tertiary higher-grade pattern (TP) are associated with increased stage and/or biochemical recurrence following RP when compared with their closest grading counterpart (eg, 4 þ 3 ¼ 7 with tertiary pattern 5 compared with 4 þ 3 ¼ 7). Paradoxically however, TPs are not routinely incorporated into predictive clinical models.…”

mentioning

confidence: 99%

“…Paradoxically however, TPs are not routinely incorporated into predictive clinical models. [23][24][25] While most tertiary grading studies have defined the term as minor/less than 5%, 3,4,[11][12][13][14][15][16][17][18] this is not universal, [6][7][8][9][10]26 and no study has ever documented practice patterns across a range of grading scenarios. Understanding how and when tertiary grades are assigned has become more intriguing with the introduction of a prognostic Grade Group system.…”

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confidence: 99%

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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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Tertiary Gleason pattern in radical prostatectomy specimens is associated with worse outcomes than the next higher Gleason score group in localized prostate cancer

Cited by 12 publications

References 27 publications

Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy

Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy

Ultrasensitive prostate‐specific antigen level as a predictor of biochemical progression after robot‐assisted radical prostatectomy: Towards risk adapted follow‐up

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

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