Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Oct;182(4):1364-70.
doi: 10.1016/j.juro.2009.06.048. Epub 2009 Aug 14.

Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system

Bruce J Trock  1 , Charles C Guo, Mark L Gonzalgo, Ahmed Magheli, Stacy Loeb, Jonathan I Epstein
Affiliations

Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system

Bruce J Trock et al. J Urol. 2009 Oct.

Abstract

Purpose: We investigated the relationship between the tertiary Gleason component in radical prostatectomy specimens and biochemical recurrence in what is to our knowledge the largest single institution cohort to date.

Materials and methods: We evaluated data on 3,230 men who underwent radical prostatectomy at our institution from 2000 to 2005. Tertiary Gleason component was defined as Gleason grade pattern 4 or greater for Gleason score 6 and Gleason grade pattern 5 for Gleason score 7 or 8.

Results: Biochemical recurrence curves for cancer with tertiary Gleason component were intermediate between those of cancer without a tertiary Gleason component in the same Gleason score category and cancer in the next higher Gleason score category. The only exception was that Gleason score 4 + 3 = 7 with a tertiary Gleason component behaved like Gleason score 8. The tertiary Gleason component independently predicted recurrence when factoring in radical prostatectomy Gleason score, radical prostatectomy stage and prostate specific antigen (HR 1.45, p = 0.029). Furthermore, the magnitude of the tertiary Gleason component effect on recurrence did not differ by Gleason score category (p = 0.593).

Conclusions: Although the tertiary Gleason component is frequently included in pathology reports, it is routinely omitted in other situations, such as predictive nomograms, research studies and patient counseling. The current study adds to a growing body of evidence highlighting the importance of the tertiary Gleason component in radical prostatectomy specimens. Accordingly consideration should be given to a modified radical prostatectomy Gleason scoring system that incorporates tertiary Gleason component in intuitive fashion, including Gleason score 6, 6.5 (Gleason score 6 with tertiary Gleason component), 7 (Gleason score 3 + 4 = 7), 7.25 (Gleason score 3 + 4 = 7 with tertiary Gleason component), 7.5 (Gleason score 4 + 3), 8 (Gleason score 4 + 3 with tertiary Gleason component or Gleason score 8), 8.5 (Gleason score 8 with tertiary Gleason component), 9 (Gleason score 4 + 5 or 5 + 4) and 10.

PubMed Disclaimer

Figures

Figure 1
Figure 1
BRFS in men with GS 6 or less without TGC (black curve), 6 or less with TGC (red curve) and 3 + 4 without TGC (blue curve). Log rank chi-square (2 df) 68.7, p < 0.0001.
Figure 2
Figure 2
BRFS in men with GS 3 + 4 without TGC (black curve), 3 + 4 with TGC (red curve) and 4 + 3 without TGC (blue curve). Log rank chi-square (2 df) 52.5, p < 0.0001.
Figure 3
Figure 3
BRFS in men with GS 4 + 3 without TGC (black curve), 4 + 3 with TGC (red curve) and 8 without TGC (blue curve). Log rank chi-square (2 df) 1.8, p = 0.409.
Figure 4
Figure 4
BRFS in men with GS 8 without TGC (black curve), 8 with TGC (red curve) and 9 to 10 without TGC (blue curve). Log rank chi-square (2 df) 16.6, p = 0.0003.
See this image and copyright information in PMC

Comment in

References

    1. Mellinger GT, Gleason D, Bailar J., 3rd The histology and prognosis of prostatic cancer. J Urol. 1967;97:331. - PubMed
    1. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 1974;111:58. - PubMed
    1. Epstein JI, Allsbrook WC, Jr, Amin MB, et al. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005;29:1228. - PubMed
    1. Harnden P, Shelley MD, Coles B, et al. Should the Gleason grading system for prostate cancer be modified to account for high-grade tertiary components? A systematic review and meta-analysis. Lancet Oncol. 2007;8:411. - PubMed
    1. Hattab EM, Koch MO, Eble JN, et al. Tertiary Gleason pattern 5 is a powerful predictor of biochemical relapse in patients with Gleason score 7 prostatic adenocarcinoma. J Urol. 2006;175:1695. - PubMed

Substances