INTRODUCTION: The prognostic significance of a tertiary Gleason pattern (TGP) in radical prostatectomy (RP) specimen is controversially debated.
The aim of the current study was to test the impact of a TGP on adverse histopathological features and biochemical recurrence (BCR) rate after RP.
MATERIAL AND METHODS: We relied on the data of 11226 consecutive patients who were treated with RP at our institution between June 2007 and February 2013. We compared patients with (n=2396; 22.4%) vs. without (n=; 8260 77.8%) TGP for presence of adverse histopathological features (extraprostatic extension, seminal vesicle invasion, positive surgical margins, and lymph node invasion) using the chi-square test. The effect of TGP on BCR was tested in univariable and multivariable models. Subsequently, subanalyses were performed for different RP Gleason-groups (≤ 6, 3+4, and 4+3).
RESULTS: Presence of a TGP was statistically significantly associated with all evaluated histopathological parameters (p-values < 0.001, each), and an independent predictor of BCR (HR=1.43; p< 0.001). In subanalyses, TGP only independently predicted BCR in the patient cohort with a RP Gleason-Score 3+4 and 4+3, while it failed to reach independent predictor status in patients with RP Gleason-Score ≤ 6.
CONCLUSION: Presence of a TGP is a significant and independent predictor of BCR after RP and exerts its strongest prognostic effect in Gleason-Scores 3+4 and 4+3. TGP should therefore consequently be recorded in the pathological report.
Written by:
Adam M, Hannah A, Budäus L, Steuber T, Salomon G, Michl U, Haese A, Fisch M, Wittmer C, Steurer S, Minner S, Heinzer H, Huland H, Graefen M, Sauter G, Schlomm T, Isbarn H. Are you the author?
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf; University Medical Center Hamburg-Eppendorf, Department of Urology; University Medical Center Hamburg-Eppendorf, Department of Pathology.
Reference: J Urol. 2014 Feb 8. pii: S0022-5347(14)00051-2.
doi: 10.1016/j.juro.2014.01.029
PubMed Abstract
PMID: 24518778
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