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J Urol. 2011 Oct;186(4):1286-90. doi: 10.1016/j.juro.2011.05.075.

Gleason score 7 prostate cancer on needle biopsy: relation of primary pattern 3 or 4 to pathological stage and progression after radical prostatectomy.

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  • 1Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Abstract

PURPOSE:

There have been only a few contradictory publications assessing whether Gleason score 4 + 3 = 7 has a worse prognosis than 3 + 4 = 7 on biopsy material in predicting pathological stage and biochemical recurrence. Older studies predated the use of the modified Gleason grading system established in 2005.

MATERIALS AND METHODS:

We retrospectively studied 1,791 cases of Gleason score 7 on prostatic biopsy to determine whether the breakdown of Gleason score 7 into 3 + 4 vs 4 + 3 has prognostic significance in the modern era.

RESULTS:

There was no difference in patient age, preoperative serum prostate specific antigen, maximum tumor percent per core or the number of positive cores between Gleason score 3 + 4 = 7 and Gleason score 4 + 3 = 7. Gleason score 4 + 3 = 7 showed an overall correlation with pathological stage (organ confined, focal extraprostatic extension, nonfocal extraprostatic extension, seminal vesicle invasion/lymph node metastases, p = 0.005). On multivariate analysis Gleason score 4 + 3 = 7 (p = 0.03), number of positive cores (p = 0.002), maximum percent of cancer per core (p = 0.006) and preoperative serum prostate specific antigen (p = 0.03) all correlated with pathological stage. Gleason score 4 + 3 = 7 on biopsy was also associated with an increased risk of biochemical progression after radical prostatectomy (p = 0.0001). On multivariate analysis Gleason score 4 + 3 = 7 (p = 0.001), maximum percent of cancer per core (p <0.0001) and preoperative serum prostate specific antigen (p <0.0001) but not number of positive cores correlated with the risk of biochemical progression after radical prostatectomy.

CONCLUSIONS:

Our study further demonstrates that Gleason score 7 should not be considered a homogenous group for the purposes of disease management and prognosis.

Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Comment in

  • Editorial comment. [J Urol. 2011]
PMID:
21862072
[PubMed - indexed for MEDLINE]
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