194 PRESENCE OF A HIGH GRADE TERTIARY GLEASON PATTERN UPGRADES THE GLEASON SUM SCORE AND INVERSELY ASSOCIATED WITH BIOCHEMICAL RECURRENCE-FREE SURVIVAL

Abstract

You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011194 PRESENCE OF A HIGH GRADE TERTIARY GLEASON PATTERN UPGRADES THE GLEASON SUM SCORE AND INVERSELY ASSOCIATED WITH BIOCHEMICAL RECURRENCE-FREE SURVIVAL Polat Turker, Emine Bas, Suheyla Bozkurt, Bulent Gunlusoy, Arsenal Sezgin, Hakan Postaci, and Levent Turkeri Polat TurkerPolat Turker Tekirdag, Turkey More articles by this author , Emine BasEmine Bas Istanbul, Turkey More articles by this author , Suheyla BozkurtSuheyla Bozkurt Istanbul, Turkey More articles by this author , Bulent GunlusoyBulent Gunlusoy Izmir, Turkey More articles by this author , Arsenal SezginArsenal Sezgin Izmir, Turkey More articles by this author , Hakan PostaciHakan Postaci Izmir, Turkey More articles by this author , and Levent TurkeriLevent Turkeri Istanbul, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.264AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tumor heterogeneity is a common finding and led to realization of a tertiary Gleason component (TGC) in prostate cancer. In an attempt to further investigate its prognostic value, we analyzed the association of tertiary Gleason pattern in Gleason score less than/equal to 7 tumors with pathologic stage and biochemical disease-free survival. METHODS 331 radical prostatectomy specimens were analyzed retrospectively. The primary, secondary and the tertiary patterns were evaluated by reviewing all of the pathological slides. TGC was defined as Gleason grade pattern 4 or 5 for Gleason score less than 7 tumors and Gleason grade pattern 5 for Gleason score 7 tumors. The pathological prognostic factors, (extraprostatic extension, seminal vesicle and lymph node invasion, surgical margin status) of Gleason score less than 7, 3+4 and 4+3 tumors with or without TGC were compared. Biochemical recurrence free survival (BRFS) was calculated using Kaplan Meier method with log rank test and the influence of TGC was assessed in a Cox regression model. RESULTS TGC observed more frequently with higher Gleason scores (21% of the GS less than 7 cases, 23% of the GS 3+4 cases and 58% of the GS 4+3 cases). In terms of adverse pathological prognostic factors and BRFS, GS<7 tumors with TGC behaved significantly worse than GS<7 tumors without TGC (p=0.01 and p=0.001 respectively) with properties similar to GS 3+4 tumors without TGC. Gleason score 3+4 and 4+3 tumors without TGC were statistically similar and have better features than corresponding tumors of same Gleason score with TGC. Furthermore, Gleason score 7 tumors with TGC have similar features with GS 8-10 tumors. During follow-up 73 (22%) subjects had PSA recurrence. In the Cox regression model TGC was an independent variable for BRFS (HR=2.63, 95% CI=1.39–4.98, p=0.003). CONCLUSIONS According to the present study, 3 different prognostic groups were observed; good prognostic group: GS <7, intermediate prognostic group: GS<7+TGC, GS 3+4 and GS 4+3, and finally bad prognostic group: GS (3+4)+TGC, GS (4+3)+TGC,GS>7. Presence of a TGC appears to upgrade the total score and adjuvant treatment decisions may further be refined by considering the tertiary pattern. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e80-e81 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Polat Turker Tekirdag, Turkey More articles by this author Emine Bas Istanbul, Turkey More articles by this author Suheyla Bozkurt Istanbul, Turkey More articles by this author Bulent Gunlusoy Izmir, Turkey More articles by this author Arsenal Sezgin Izmir, Turkey More articles by this author Hakan Postaci Izmir, Turkey More articles by this author Levent Turkeri Istanbul, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...