TY - JOUR
T1 - Prevalence of a Tertiary Gleason Grade and Its Impact on Adverse Histopathologic Parameters in a Contemporary Radical Prostatectomy Series
AU - Isbarn, Hendrik
AU - Ahyai, Sascha A.
AU - Chun, Felix K.H.
AU - Budäus, Lars
AU - Schlomm, Thorsten
AU - Salomon, Georg
AU - Zacharias, Mario
AU - Erbersdobler, Andreas
AU - Köllermann, Jens
AU - Sauter, Guido
AU - Huland, Hartwig
AU - Graefen, Markus
AU - Steuber, Thomas
PY - 2009/2
Y1 - 2009/2
N2 - Background: The presence of a tertiary Gleason grade (TGG) pattern in radical prostatectomy (RP) specimens has been described as associated with adverse pathology and a higher biochemical recurrence (BCR) rate after RP. Objective: To assess the prevalence of a TGG in a contemporary, consecutive, single-centre RP series and its association with adverse pathology. Design, setting, and participants: From January to August 2007, 800 eligible patients (no prior neoadjuvant hormonal therapy) underwent RP for clinically localised prostate cancer (pCA) in our institution. The presence of the third most prevalent Gleason pattern was documented, regardless of whether it was better or worse than the two predominant Gleason grades. Measurements: The overall prevalence of a TGG was described. Uni- and multivariate logistic regression analyses tested the association between the presence of a TGG <5% versus ≥5% of the whole tumour volume and extracapsular extension (ECE), seminal vesicle invasion (SVI), positive surgical margins (PSM), and lymph node invasion (LNI). Subanalyses were performed to assess the impact of different TGGs at various Gleason scores. Results and limitations: A TGG was reported in 180 RP specimens (22.5%). In univariate analysis, the presence of a TGG ≥5% was significantly associated with ECE, SVI, PSM, and LNI (p < 0.001). In multivariate analysis, a TGG ≥5% showed an independent association with ECE and PSM (p < 0.05). Accordingly, in subanalyses, a significant association with adverse pathology was only documented if the amount of a TGG was at least 5% of the tumour volume. Our study is limited by the relatively low overall frequency of a TGG, thereby reducing the statistical expressiveness, especially for subanalyses. Conclusions: Our findings confirm the association of the presence of a TGG with adverse pathologic features. Further follow-up is needed to assess the prognostic impact of a TGG on the risk of BCR and overall survival following RP.
AB - Background: The presence of a tertiary Gleason grade (TGG) pattern in radical prostatectomy (RP) specimens has been described as associated with adverse pathology and a higher biochemical recurrence (BCR) rate after RP. Objective: To assess the prevalence of a TGG in a contemporary, consecutive, single-centre RP series and its association with adverse pathology. Design, setting, and participants: From January to August 2007, 800 eligible patients (no prior neoadjuvant hormonal therapy) underwent RP for clinically localised prostate cancer (pCA) in our institution. The presence of the third most prevalent Gleason pattern was documented, regardless of whether it was better or worse than the two predominant Gleason grades. Measurements: The overall prevalence of a TGG was described. Uni- and multivariate logistic regression analyses tested the association between the presence of a TGG <5% versus ≥5% of the whole tumour volume and extracapsular extension (ECE), seminal vesicle invasion (SVI), positive surgical margins (PSM), and lymph node invasion (LNI). Subanalyses were performed to assess the impact of different TGGs at various Gleason scores. Results and limitations: A TGG was reported in 180 RP specimens (22.5%). In univariate analysis, the presence of a TGG ≥5% was significantly associated with ECE, SVI, PSM, and LNI (p < 0.001). In multivariate analysis, a TGG ≥5% showed an independent association with ECE and PSM (p < 0.05). Accordingly, in subanalyses, a significant association with adverse pathology was only documented if the amount of a TGG was at least 5% of the tumour volume. Our study is limited by the relatively low overall frequency of a TGG, thereby reducing the statistical expressiveness, especially for subanalyses. Conclusions: Our findings confirm the association of the presence of a TGG with adverse pathologic features. Further follow-up is needed to assess the prognostic impact of a TGG on the risk of BCR and overall survival following RP.
KW - Gleason score
KW - Prostate cancer
KW - Radical prostatectomy
KW - Tertiary Gleason grade
UR - https://www.scopus.com/pages/publications/57649202139
UR - https://www.scopus.com/inward/citedby.url?scp=57649202139&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2008.08.015
DO - 10.1016/j.eururo.2008.08.015
M3 - Article
C2 - 18718699
AN - SCOPUS:57649202139
SN - 0302-2838
VL - 55
SP - 394
EP - 403
JO - European Urology
JF - European Urology
IS - 2
ER -
