Biochemical Recurrence Related to Tertiary Gleason Patterns at Radical Prostatectomy (RP)
BJ Trock, CC Guo, JI Epstein. Johns Hopkins Hospital, Baltimore
Background: Only limited data from heterogeneous patient cohorts are available to evaluate the long-term clinical significance of a higher tertiary Gleason pattern at RP.
Design: We evaluated data on 7,219 men who underwent RP at our institution from 1984-2005 and had available pathology and clinical outcome data. Tertiary Gleason patterns were defined as Gleason pattern >4 for Gleason score 6 and Gleason pattern 5 for Gleason score 7 or 8; Gleason scores 9-10 were not considered to have tertiary Gleason patterns.
Results: There were 406 men (6%) with tertiary Gleason patterns. Men with tertiary Gleason patterns had significantly higher preoperative serum PSA levels (p=0.017) and biopsy Gleason score (p<0.0001) than men without tertiary Gleason patterns. For men with tertiary Gleason patterns, recurrence-free survival curves were intermediate between those of men without tertiary Gleason patterns in the same Gleason score category and men in the next higher Gleason score category. For example, tumors with Gleason score 3+4=7 with tertiary pattern 5 had a prognosis in between those of 3+4=7 without tertiary pattern 5 and those of 4+3=7 without tertiary pattern 5. For men with Gleason 4+3 in particular, the presence of tertiary Gleason pattern 5 decreased recurrence-free survival to a level very close to that of Gleason score 8 without tertiary Gleason pattern 5. The presence of a tertiary Gleason pattern was an independent prognostic factor in a proportional hazards model that included RP Gleason score, pathology stage, PSA and year of surgery, hazard ratio=1.3 (95% CI: 1.02-1.62), p=0.033.
Conclusions: In this the largest study to date of tertiary Gleason patterns at RP, the presence of tertiary Gleason patterns was associated with lower recurrence-free survival for all Gleason score categories. These data suggest that tertiary Gleason patterns should be evaluated and included in pathology reports of RP specimens. In most cases the presence of tertiary Gleason patterns produce survival intermediate between two adjacent Gleason score categories.
Category: Genitourinary (including renal tumors)
Monday, March 9, 2009 1:15 PM
Platform Session: Section A, Monday Afternoon