Elsevier

Human Pathology

Volume 45, Issue 11, November 2014, Pages 2263-2269
Human Pathology

Original contribution
Adenocarcinoma of the prostate with Gleason pattern 5 on core biopsy: frequency of diagnosis, morphologic subpatterns, and relation to pattern distribution based on the modified Gleason grading system

https://doi.org/10.1016/j.humpath.2014.07.012Get rights and content

Summary

Accurate recognition of Gleason pattern 5 (GP5) prostate adenocarcinoma (PCa) on core biopsy (NBX) is critical because it is associated with disease progression and the worst clinical outcome. We evaluated 1557 consecutive and prospectively collected NBXs to determine the frequency of diagnosis, morphologic subpatterns, and their relation to the amount and pattern distribution of GP5 PCa based on the 2005 modified Gleason grading system. Tertiary GP5 was upgraded to a secondary pattern to derive the final Gleason score. GP5 accounted for 6% of all NBXs and 14% of PCa cases. GP5 PCas were associated with high-risk preoperative clinical and biopsy characteristics, regardless of the amount of GP5. Most patients (85%) with % GP5 greater than 5% of PCa had the final Gleason score of 9 to 10, compared with % GP5 of 5% or less of PCa (P < .0001). The morphologic subpatterns of GP5 PCas were as follows: infiltrating cords (96%), single cells (76%), solid sheets (29%), and comedocarcinoma (2%). Infiltrating cords and single-cell patterns frequently coexisted (76%). The GP5 was distributed in a tertiary (66%), followed by secondary (32%) and primary (2%) components of PCa. Infiltrating cords and single cells were the 2 most frequently encountered patterns, specifically when GP5 involved 5% or less of PCa and represented secondary or tertiary component of PCa. GP5 PCa is a relatively frequent presentation in the contemporary NBX practice. Because of its important prognostic and therapeutic implications, pathologists must be aware of its varied morphologic presentations and to the fact that most cases with GP5 represent a tertiary component of PCa.

Section snippets

Introdution

The Gleason score assigned on a prostate needle biopsy (NBX) represents a quintessential variable that determines the prognosis and management of patients with prostate adenocarcinoma (PCa) [1], [2], [3]. The presence of Gleason pattern 5 in NBX classifies the PCa typically into Gleason score 8 to 10, a group that has traditionally been lumped in a high-grade category for patient management.

Pierorazio et al [4] recently proposed a prognostic Gleason grade grouping for PCa patients based on the

Materials and methods

The study cohort included 1557 consecutive patients with prostate needle biopsies containing any amount of Gleason pattern 5 PCa. All biopsies were performed from 2010 to 2013 in our institution, and the institutional review board approved the study. A standard 10- or 12-core extended biopsy protocol with site-specific submission was routinely used.

Preoperative clinical and biopsy characteristics analyzed included age, serum prostate-specific antigen (PSA), the number of biopsy cores, the

Frequency of Gleason Pattern 5 PCa component

Of 1557 NBX cases, PCa was detected in 664 cases (43%). Gleason pattern 5 was present in 94 (6%) of all NBX cases. Of 664 PCa cases, Gleason pattern 5 represented 14% of cases.

Preoperative clinical and biopsy characteristics associated with 94 PCa cases with a component of Gleason pattern 5

The mean age was 71 years (range, 47-92). The mean and median serum PSA values were 39 and 63 (range, 2.5-1469 ng/mL), respectively. Thirty-four (36%) patients were classified as Gleason score 3 + 5 = 8; one (1%), 5 + 3; 58 (62%), 4 + 5 = 9; and 1 (1%), 5 + 4 = 9. The biopsy characteristics expressed as mean value

Discussion

The frequency of Gleason pattern 5 PCa, its distribution pattern and its relation to morphology in reference to the 2005 ISUP modified Gleason grading system have not been systematically studied. Our study demonstrates that Gleason pattern 5 is a relatively frequent presentation in a contemporary NBX practice setting. Gleason pattern 5 was observed in 94 (6%) of 1557 prospectively collected prostate biopsies. Of 664 cancer cases, Gleason pattern 5 was present in 14% of cases. In a

Acknowledgment

The authors would like to thank Robert Genta, MD, for assistance with statistical analysis and Suzanne Ridner for editorial assistance.

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    These two sub-patterns co-occur frequently. Single cells were found along with infiltrative cords in 76% of cases in the series by Shah and Tadros.36 Gottipati et al. made a distinction between infiltrative cords and single files and found that they co-occurred with single cells in 44% and 84% of cases.26

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    However, this lack of information affects all treatment cohorts equally. Finally, the pathologic identification of GP 5 disease can be challenging, with some interobserver variability (46, 47). Clearly, centralized pathologic review is not applicable in the setting of a large population-based database.

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Disclosure: The authors have no conflict of interest or funding disclosure to report related to this work.

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