Abstract
The Gleason score is an important parameter for clinical outcome in prostate cancer patients. Gleason score 8 is a heterogeneous disease including Gleason score 3 + 5, 4 + 4, and 5 + 3 tumors, and encompasses a broad range of tumor growth patterns. Our objective was to characterize individual growth patterns and identify prognostic parameters in Gleason score 8 prostate cancer patients. We reviewed 1064 radical prostatectomy specimens, recorded individual Gleason 4 and 5 growth patterns as well as presence of intraductal carcinoma, and evaluated biochemical recurrence- and metastasis-free survival. Gleason score 8 disease was identified in 140 (13%) patients, of whom 76 (54%) had Gleason score 3 + 5, 46 (33%) 4 + 4, and 18 (13%) 5 + 3 disease. Invasive cribriform and/or intraductal carcinoma (n = 87, 62%) was observed more frequently in Gleason score 4 + 4 (93%) than 3 + 5 (47%; P < 0.001) and 5 + 3 (44%; P < 0.001) patients. Gleason pattern 5 was present in 110 (79%) men: as single cells and/or cords in 99 (90%) and solid fields in 32 (29%) cases. Solid field pattern 5 coexisted with cribriform architecture (23/32, 72%) more frequently than nonsolid pattern 5 cases (36/78, 46%, P = 0.02). In multivariable analysis including age, prostate-specific antigen, pT-stage, surgical margin status, and lymph node metastases, presence of cribriform architecture was an independent parameter for biochemical recurrence-free (hazard ratio (HR) 2.0, 95% confidence interval (CI) 1.0–3.7; P = 0.04) and metastasis-free (HR 3.5, 95% CI 1.0–12.3; P = 0.05) survival. In conclusion, invasive cribriform and/or intraductal carcinoma occurs more frequently in Gleason score 4 + 4 prostate cancer patients than in Gleason score 3 + 5 and 5 + 3, and is an independent parameter for biochemical recurrence and metastasis. Therefore, cribriform architecture has added value in risk stratification of Gleason score 8 prostate cancer patients.
Highlights
The Gleason grading system for prostate cancer is based on classification of histomorphological growth patterns [1]
At the 2014 meeting of the International Society of Urological Pathology (ISUP), consent was reached that a Grade Group should be reported in conjunction with the Gleason score, based on the initial work of Pierorazio et al which was endorsed by the World Health Organization (WHO) in 2016 [2,3,4]
Not incorporated in the Gleason score or Grade Group, intraductal carcinoma is independently associated with adverse oncological outcome [8, 14, 15]
Summary
The Gleason grading system for prostate cancer is based on classification of histomorphological growth patterns [1]. Grade Group 4 prostate cancer encompasses Gleason score 8 tumors, including Gleason score 3 + 5, 5 + 3, and 4 + 4 [5, 6]. It is not yet clear whether these three Gleason score 8 subgroups have similar clinical outcome. The adverse impact of invasive cribriform and intraductal carcinoma has mainly been studied in Gleason score 3 + 4 prostate cancer, as it might affect clinical decisionmaking in this patient population in particular. Some studies indicate that presence of invasive cribriform and intraductal carcinoma has independent predictive value in Gleason score 8 prostate cancer patients [14, 16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
