Prostate Cancer With Tertiary Gleason Pattern 5 in Prostate Needle Biopsy Clinicopathologic Findings and Disease Progression

Significance of tertiary Gleason pattern/grade 5 oil prostatectomy has been studied, but its significance on biopsy remains uncertain. Recent International Society of Urological Pathology consensus conference recommended that biopsy Gleason score is generated by adding tertiary grade 5 to the primary grade. We examined the preoperative clinical and biopsy findings in 53 patients with biopsy tertiary pattern 5 and 119 patients with primary/secondary biopsy pattern 5. Prostatectomy findings and prostate-specific antigen (PSA) failure rates were compared ill Surgically treated patients. Cause-specific and all-cause mortality were compared in patients treated nonsurgically. At presentation, age, gland volume, PSA, and biopsy cancer Volume were similar in patients with tertiary and primary/secondary grade 5. Only 20 patients underwent prostatectomy and 152 were treated nonsurgically. Regardless of the pattern, patients treated by prostatectomy were younger (P = 0.003), had lower PSA (P = 0.001), and less-cancer oil biopsy (P = 0.0001). Prostatectomy findings and PSA failures were not significantly different in patients with tertiary grade 5 versus primary/secondary pattern 5. In nonsurgically treated patients, patients with primary pattern 5 compared with those with tertiary pattern 5 had a significantly higher risk of all-cause mortality [adjusted hazard ratio (HR): 2.33, 95% confidence interval (Cl): 1.10-4.90, P = 0.026] and cause-specific mortality (adjusted HR: 7.52, 95% CI: 2.84-19.87, P < 0.001), In contrast, patients with secondary pattern 5 had a comparable all-cause mortality risk to patients with tertiary pattern 5 (adjusted HR: 1.04, 95% CI: 0.47-2.32, P = 0.92), but had a marginally higher risk of cause-specific mortality than patients with tertiary pattern 5 (adjusted HR: 2.13, 95% CI: 0.75-6.10, P = 0.16).