Skip to main content
SpringerLink
Log in

Gleason 5+4 Has Worse Oncological and Pathological Outcomes Compared with Gleason 4+5: Significance of Gleason 5 Pattern

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to evaluate the pathological and oncological significance of Gleason (G) 5 pattern in high-grade PCa after robotic-assisted radical prostatectomy (RARP).

Materials and Methods

From a cohort of 1,046 men, 159 post-RARP patients by a single surgeon with pathological G8 (N = 79) and G9 (N = 80) met our inclusion criteria. G9 cancers were sub-stratified into G4+5 (N = 58) and G5+4 (N = 22). Clinical and pathological outcomes were evaluated with the t test or Mann–Whitney U test for continuous variables and the Pearson χ 2 test for categorical variables. The Kaplan–Meier method was used to estimate the biochemical recurrence-free survival (BCRFS), and survival curves were compared using the log-rank test. Multivariate analysis was performed with Cox regression analysis.

Results

Baseline characteristics across all subgroups were similar except for number of positive cores on biopsy. There was a trend toward worse pathological and oncological outcomes in G9 cancers when compared with G8, although only tumor volume (TV), extracapsular extension (ECE) of tumor and lymph nodes involvement (LNI) achieved statistical significance. G4+5 PCa were statistically more likely to have ECE and a higher TV than G4+4 although the BCRFS were not significantly different. G5+4 cancers were associated with a significantly higher proportion of patients with LNI and had a statistically significant poorer BCRFS compared with G4+5 patients.

Conclusions

Oncological and pathological outcomes of G8 were significantly better than G9 and merited distinction between them. G5+4 harbors a much poorer BCRFS compared with G4+5, and hence we suggest considerations for immediate adjuvant treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Grossfeld GD, Latini DM, Lubeck DP, Mehta SS, Carroll PR. Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer. J Urol. 2003;169:157–63.

    Article  PubMed  Google Scholar 

  2. Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin N Am. 2001;28:555–65.

    Article  CAS  Google Scholar 

  3. Donohue JF, Bianco Jr FJ, Kuroiwa K, Vickers AJ, Wheeler TM, Scardino PT, et al. Poorly differentiated prostate cancer treated with radical prostatectomy: long term outcome and incidence of pathological downgrading. J Urol. 2006;176:991–5.

    Article  PubMed  Google Scholar 

  4. Mian BM, Troncoso P, Okihara K, Bhadkamkar V, Johnston D, Reyes AO, et al. Outcome of patients with Gleason score 8 or higher prostate cancer following radical prostatectomy alone. J Urol. 2002;167:1675–80.

    Article  PubMed  Google Scholar 

  5. Pierorazio PM, Ross AE, Lin BM, Epstein JI, Han M, Walsh PC, et al. Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy. BJU Int. 2012;110:1122–8.

    Article  PubMed  Google Scholar 

  6. Wambi CO, Siddiqui SA, Krane LS, Agarwal PK, Stricker HJ, Peabody JO. Early oncological outcomes of robot-assisted radical prostatectomy for high-grade prostate cancer. BJU Int. 2010;106:1739–45.

    Article  PubMed  Google Scholar 

  7. Tolonen TT, Kujala PM, Tammela TL, Tuominen VJ, Isola JJ, Visakorpi T. Overall and worst Gleason scores are equally good predictors of prostate cancer progression. BMC Urol. 2011;11:21–5.

    Article  PubMed  Google Scholar 

  8. Nanda A, Chen MH, Renshaw AA, D’Amico AV. Gleason Pattern 5 prostate cancer: further stratification of patients with high-risk disease and implications for future randomized trials. Int J Radiat Oncol Biol Phys. 2009;74:1419–23.

    Article  PubMed  Google Scholar 

  9. Alenda O, Ploussard G, Mouracade P, Xylinas E, de la Taille A, Allory Y, et al. Impact of the primary Gleason pattern on biochemical recurrence-free survival after radical prostatectomy: a single-center cohort of 1,248 patients with Gleason 7 tumors. World J Urol. 2011;29:671–6.

    Article  PubMed  CAS  Google Scholar 

  10. McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA. Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate. Cancer. 1990;66:1225–33.

    Article  PubMed  CAS  Google Scholar 

  11. Stamey TA, McNeal JE, Yemoto CM, Sigal BM, Johnstone IM. Biological determinants of cancer progression in men with prostate cancer. JAMA. 1999;281:1395–400.

    Article  PubMed  CAS  Google Scholar 

  12. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD, et al. European Association of Urology guidelines on prostate cancer. http://www.uroweb.org. Accessed Oct 2012.

  13. American Urological Association guideline for the management of clinically localized prostate cancer: 2007 update. http://www.auanet.org. Accessed Oct 2012.

  14. NCCN clinical practice guidelines in prostate cancer. http://www.nccn.org. Accessed Oct 2012.

  15. Gerber GS, Thisted RA, Chodak GW, Schroder FH, Frohmuller HG, Scardino PT, et al. Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institution pooled analysis. Eur Urol. 1997;32:385–90.

    PubMed  CAS  Google Scholar 

  16. Lau WK, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Radical prostatectomy for pathological Gleason 8 or greater prostate cancer: influence of concomitant pathological variables [erratum published in J Urol. 2004;171:811]. Erratum. J Urol. 2002;167:117–22.

    Google Scholar 

  17. Tefilli MV, Gheiler EL, Tiguert R, Banerjee M, Sakr W, Grignon D, et al. Role of radical prostatectomy in patients with prostate cancer of high Gleason score. Prostate. 1999;39:60–6.

    Article  PubMed  CAS  Google Scholar 

  18. Lughezzani G, Gallina A, Larcher A, Briganti A, Capitanio U, Suardi N, et al. Radical prostatectomy represents an effective treatment in patients with specimen-confined high pathological Gleason score prostate cancer. BJU Int. 2013;111:723–30.

    Article  PubMed  CAS  Google Scholar 

  19. Serni S, Masieri L, Minervini A, Lapini A, Nesi G, Carini M. Cancer progression after anterograde radical prostatectomy for pathologic Gleason score 8 to 10 and influence of concomitant variables. Urology. 2006;67:373–8.

    Article  PubMed  Google Scholar 

  20. Patel AA, Chen M, Renshaw AA, D’Amico AV. PSA failure following definitive treatment of prostate cancer having biopsy Gleason score 7 with tertiary grade 5. JAMA. 2007;298:1533–8.

    Article  PubMed  CAS  Google Scholar 

  21. Pan CC, Potter SR, Partin AW, Epstein JI. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens. Am J Surg Pathol. 2000;24:563–9.

    Article  PubMed  CAS  Google Scholar 

  22. Cheng L, Koch MO, Juliar BE, Daggy JK, Foster RS, Bihrle R, et al. The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy. J Clin Oncol. 2005;23:2911–7.

    Article  PubMed  Google Scholar 

  23. Zelefsky MJ, Levin EJ, Hunt M, Yamada Y, Shippy AM, Jackson A, et al. Incidence of late rectal and urinary toxicities after three dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:1124–9.

    Article  PubMed  Google Scholar 

  24. Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L, et al. European Organization for Research and Treatment of Cancer. Postoperative radiotherapy after radical prostatectomy: a randomized controlled trial (EORTC trial 22911). Lancet. 2005;366:572–8.

    Article  PubMed  Google Scholar 

  25. Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Störkel S, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009;27:2924–30.

    Article  PubMed  Google Scholar 

  26. Swanson GP, Thompson IM, Tangen C, Paradelo J, Canby-Hagino E, Crawford ED, et al. Update of SWOG 8794: adjuvant radiotherapy for pT3 prostate cancer improves metastasis free survival. Int J Radiat Oncol Biol Phys. 2008;72:S31–3.

    Article  Google Scholar 

  27. Gontero P, Spahn M, Tombal B, Bader P, Hsu CY, Marchioro G, et al. Is there a prostate-specific antigen upper limit for radical prostatectomy? BJU Int. 2011;108:1093–100.

    Article  PubMed  Google Scholar 

  28. Lee N, Fawaaz R, Olsson CA, Benson MC, Petrylak DP, Schiff PB, et al. Which patients with newly diagnosed prostate cancer need a radionuclide bone scan? An analysis based on 631 patients. Int J Radiat Oncol Biol Phys. 2000;48:1443–6.

    Article  PubMed  CAS  Google Scholar 

  29. Kwan WB, Pickles T, Paltiel C, for the Prostate Cancer Outcomes Initiative. Does PSA failure in prostate cancer patients necessarily increase the risk of prostate cancer related death? An analysis in a cohort of 1790 patients. Proc Am Soc Clin Oncol. 2003;22:380–7. Abstract 1526.

    Google Scholar 

Download references

Acknowledgment

This study was supported by a Research Foundation of Korea (NRF) Grant funded by the Korean government (MEST) (2011-0029348).

Author information

Authors and Affiliations

  1. Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

    Sey Kiat Lim MBBS, MRCS, MMed, FAMS, Kwang Hyun Kim MD, Tae-Young Shin MD, Byung Ha Chung MD, PhD, Sung Joon Hong MD, PhD, Young Deuk Choi MD, PhD & Koon Ho Rha MD, PhD, FACS

Authors
  1. Sey Kiat Lim MBBS, MRCS, MMed, FAMS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kwang Hyun Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae-Young Shin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byung Ha Chung MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sung Joon Hong MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Young Deuk Choi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koon Ho Rha MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koon Ho Rha MD, PhD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lim, S.K., Kim, K.H., Shin, TY. et al. Gleason 5+4 Has Worse Oncological and Pathological Outcomes Compared with Gleason 4+5: Significance of Gleason 5 Pattern. Ann Surg Oncol 20, 3127–3132 (2013). https://doi.org/10.1245/s10434-013-2996-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-2996-4

Keywords

Search

Navigation