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RESIDENT’S CORNER

Correlation of the primary Gleason pattern on prostate needle biopsy with clinicopathological factors in Gleason 7 tumors

Ethan D. Grober, John Tsihlias, Michael A. S. Jewett, Joan M. Sweet, Andrew J. Evans, John Trachtenberg, Mike Robinette, Robert K. Nam

Division of Urology, Department of Surgery and Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Address correspondence to Dr. Ethan D. Grober, Division of Urology, University Health Network, 565-1 Eaton Wing South, 200 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada

Canadian Journal of Urology 2004, 11(1), 2157-2162.

Abstract

Objectives: To correlate the primary Gleason pattern among patients with biopsy-derived Gleason 7 tumors with the radical prostatectomy specimen Gleason grading and other clinical and pathologic outcomes.
Methods and materials: Among 474 patients who underwent radical prostatectomy for clinically localized prostate cancer between 1997-2001, 205 (43%) had Gleason 7/10 tumors on pre-operative needle biopsy. Among these patients, 148 (72.2%) were assigned a primary Gleason 3 pattern (3+4=7) and 57 (27.8%) were assigned a primary Gleason 4 pattern (4+3=7). The two groups were compared with respect to age, serum PSA levels, Gleason grade in the radical prostatectomy specimen, pathological stage and surgical margin status.
Results: Among patients with 3+4 tumors on needle biopsy, 64% remained primary Gleason grade 3 while 35% were up-graded to a primary pattern 4 following analysis of the radical prostatectomy specimen. Patients with 4+3 tumors on needle biopsy remained primary Gleason grade 4 in 51% of patients, while 49% of patients had their tumors down-graded to a primary 3 pattern (p=0.09). There were no differences between patients with needle biopsy 3+4 and 4+3 patterns with respect to total Gleason score in the radical prostatectomy specimen (p=0.42), pTNM stage (p=0.36), extra-prostatic extension (p=0.88), surgical margin involvement (p=0.16), and seminal vesicle invasion (p=0.19). In contrast, the primary Gleason pattern in the radical prostatectomy specimen correlated significantly with pTNM stage (p=0.02) and seminal vesicle invasion (p=0.003), but not with extra-prostatic extension (p=0.32) and surgical margin involvement (p=0.17).
Conclusions: Among patients with Gleason 7 adenocarcinoma of the prostate, the biopsy-derived primary Gleason pattern does not appear to correlate with important clinical and pathologic outcomes. The utility of distinguishing a primary Gleason pattern on needle biopsy among patients with Gleason 7 tumors remains unclear given the limited and conflicting literature addressing this issue.

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