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.