BERKELEY, CA (UroToday.com) - 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. Of particular significance is the correct identification of high-grade Gleason grade pattern 5 as it constitutes the most aggressive and potentially lethal prostate carcinoma. Previous studies however have demonstrated that Gleason pattern 5 remains under recognized in community practice.
To better understand the frequency of diagnosis and various clinicopathological presentations of Gleason pattern 5 that may contribute to its underdiagnosis in contemporary needle biopsy practice, we evaluated a large prospectively examined needle biopsy series using a modified 2005 Gleason grading system.
- Gleason pattern 5 prostate adenocarcinoma (PCa) was a relatively frequent presentation in contemporary needle biopsy practice accounting for 6% of all biopsy cases and 14% of cancer cases.
- The Gleason pattern 5 was most frequently distributed in a tertiary or third pattern (66%), followed by secondary (32%), and primary (2%) component of PCa. This finding may account for its under recognition in community practice.
- Certain morphological presentations of Gleason pattern 5, such as infiltrating tumor cords and single cells, were the two most frequently encountered subpatterns, specifically when Gleason pattern 5 was present as a secondary or tertiary component of prostate carcinoma or when it was quantitatively small. These two morphological presentations of Gleason pattern 5 also may contribute to its diagnostic variability/underreporting as these patterns often overlap with certain spectrums of Gleason pattern 4.
Due to the important prognostic and therapeutic implications of Gleason pattern 5 prostate carcinoma, pathologists must be aware of its varied morphological presentations, clinicopathological spectrum, and diagnostic pitfalls and to the fact that the majority of Gleason pattern 5 represents a tertiary component of carcinoma.
Rajal B. Shah, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Director, Urologic Pathology, Miraca Life Sciences, Irving, TX USA
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 - Abstract