Urology Research & Practice
Original Article

The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

1.

Department of Urology, Faculty of Medicine, Ufuk University, Ankara, Turkey

Urol Res Pract 2012; 38: 177-184
DOI: 10.5152/tud.2012.038
Read: 1383 Downloads: 1016 Published: 25 July 2019

Abstract

Objective: The aim of this study was to analyze the effect of a high-grade tertiary pattern in radical prostatectomy (RP) specimens on the histopathological results and PSA progression.

 

Material and methods: In this study, specimens from 71 patients with clinically localized prostate cancer who underwent RP between January 2007 and January 2011 in our department, who regularly attended their follow-up visits and who had a Gleason score of 5-8 (5 and 8 included) were reanalyzed by a single pathologist. The patients were evaluated for the presence of a high-grade tertiary Gleason pattern (Gleason 4 or 5). We investigated the effect of the tertiary pattern on the histopathological results and PSA progression. The patients were followed with testing for the free and total levels of PSA and given a digital rectal examination quarterly for the first two years, semiannually for the next 2 years, and annually for the remaining period. An increase in the serum total PSA count of 0.2 ng/mL or more was considered to represent PSA progression. The statistical analysis in this study was performed with SPSS for Windows Version 15.0 (Inc., Chicago, IL). p<0.05 was accepted as significant.

 

Results: The incidence of a high-grade tertiary pattern in RP specimens was found to be 15.4%. The patients were categorized into groups that were positive or negative for a tertiary pattern. When compared with the other group, the tertiary pattern positive group had higher preoperative PSA levels (p=0.469), more frequent extracapsular extension (p=0.031), more frequent lymph node (p=0.05) and seminal vesicle invasion (p=0.022) and more advanced disease in terms of the pathological stage (p=0.005). The patients were followed up for an average of 36,3 months postoperatively. PSA recurrence was found to be significantly higher in the tertiary pattern positive group (p=0.001), and the PSA progression time was shorter (p=0.001). There was no statistically significant difference between the two groups in terms of preoperative age, clinical stage, Gleason score and surgical margin positivity. When we investigated the effects of a high-grade tertiary pattern, extracapsular extension, seminal vesicle invasion, surgical margin positivity and Gleason scores on PSA recurrence according to the multivariate Cox regression analysis, only the presence of a high-grade tertiary pattern had a significant effect on PSA recurrence (p=0.034).

 

Conclusion: The presence of a high-grade tertiary pattern in the Gleason scores of RP specimens is associated with poor histopathological results and with postoperative biochemical failure. We believe that prospective studies with a higher number of patients and longer follow-up periods will more distinctly reveal the prognostic value of the tertiary pattern.

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EISSN 2980-1478