Trpkov et al. have reported on recent findings related to the significance of a tertiary finding of Gleason pattern 5 prostate cancer in a biopsy core or cores from men diagnosed with prostate cancer of otherwise lower Gleason grade. In other words, what does it mean if a man should be diagnosed as having, for example, Gleason 4 + 3 = 7 disease (based on his two most extensive Gleason patterns being Gleason grade 4 and Gleason grade 3) but there is also a small amount of evident Gleason grade 5 cancer?
A recent consensus conference of the International Society of Urological Pathology recommended that biopsy Gleason scores should clearly inform the clinician about the existence of such tertiary Gleason 5 cancer, but what it means is still open to question.
In the current study, Trpkov et al. examined the preoperative clinical and biopsy findings in 53 patients with biopsy tertiary pattern 5 and 119 patients with primary and/or secondary biopsy pattern 5. They also analyzed the post-surgical findings and prostate-specific antigen (PSA) failure rates among the surgically treated patients. A total of 20 patients underwent prostatectomy and 152 were treated nonsurgically. Thweir basic findings are as follows:
- Patients treated by prostatectomy were younger, had lower PSA levels at diagnosis, and less cancer on biopsy.
- Pathological findings post-surgery and PSA failure rates were not significantly different in patients with tertiary pattern 5 versus patients with primary and/or secondary pattern 5.
- In the non-surgically treated patients, patients with primary Gleason pattern 5 had a significantly higher risk of all-cause mortality and cause-specific mortality compared with patients who had only tertiary pattern 5.
- However, also in the non-surgically treated patients, those with secondary Gleason pattern 5 had a comparable all-cause mortality risk to patients with tertiary pattern 5 and a marginally higher risk of cause-specific mortality than patients with tertiary pattern 5.
While these data expand our understanding of the potential significance of tertiary Gleason pattern 5 in a newly diagnosed patient, trhis is a small, retrospective analysis. A larger, prospective study would be needed to get clearer insight into the clinical significance of tertiary Gleason pattern 5.