Original contributionAdenocarcinoma 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☆
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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Cited by (13)
Prognostic significance of percentage Gleason grade 5 prostatic adenocarcinoma in needle biopsies from patients treated by radical prostatectomy
2022, PathologyCitation Excerpt :Of the five grading patterns proposed by Gleason, grade 5 is the highest and is defined as carcinoma showing little or no glandular differentiation.1–3 The architectural patterns recognised in Gleason grade 5 cancers consist of sheets of cells, clusters/cords of cells, single cells and cribriform cancer with comedonecrosis, although individual cases often display more than one pattern.4 On survival analysis, all of the architectural patterns seen in grade 5 carcinoma have been shown to be associated with a poor outcome,5 with no difference in time interval to biochemical prostate specific antigen recurrence (BCR).5
Prognostic significance of morphological patterns of Gleason grade 5 prostatic adenocarcinoma diagnosed on needle biopsy
2021, PathologyCitation Excerpt :The defining morphology of Gleason grade 5 carcinomas were reviewed as part of the International Society Urological Pathology (ISUP) consensus conferences on Gleason grading in 2005 and here it was agreed that cribriform masses with comedonecrosis, with the diagnosis being based on the presence of karyorrhectic nuclei and cytoplasmic debris, should also be classified as grade 5 carcinomas.5 The current definition of grade 5 carcinoma recognises four distinct morphologies consisting of undifferentiated sheets of cells, cribriform glands with comedonecrosis, single cells and, clusters and cords of cells.6–8 Studies relating to distribution of these architectural patterns of Gleason grade 5 adenocarcinoma have been limited.
Gleason grade 5 prostate cancer: sub-patterns and prognosis
2021, PathologyCitation Excerpt :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
External Beam Radiation Therapy With a Brachytherapy Boost Versus Radical Prostatectomy in Gleason Pattern 5 Prostate Cancer: A Population-Based Cohort Study
2017, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :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.
Proposal of Gleason-like grading system of canine prostate carcinoma in veterinary pathology practice
2015, Research in Veterinary Science
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Disclosure: The authors have no conflict of interest or funding disclosure to report related to this work.