What is the clinical significance of a Gleason pattern 4 or 5 tumor found on a prostate needle core biopsy? What impact does a Gleason pattern 4 or 5 tumor have on the prognosis after radical prostatectomy?


The Gleason system of prostate cancer is based on the architectural patterns.1 The primary (predominant) and secondary (second most prevalent) patterns are recognized and assigned a grade from 1 (most differentiated) to 5 (least differentiated). Prostate cancer is noted for its multifocal occurrence of different Gleason grades. Likewise, it is not uncommon to observe more than one histologic pattern in a single mass as a greater amount of tissue is available with a radical prostatectomy specimen than a biopsy. Each tumor is given a score as the sum of two grades of these patterns. If the third most common pattern is of a lower Gleason pattern, it can be ignored. If a higher-grade component (Gleason pattern 4 or 5) is found, its presence must be reported because the tertiary higher-grade component worsens the pathologic stage of otherwise typical Gleason scores 5, 6, and 7 carcinomas and is associated with a higher PSA recurrence rate. With regards to a pattern 4 or 5 carcinoma observed in a prostate needle core biopsy, its presence should be reported as a secondary or tertiary component.


Prostate Cancer Radical Prostatectomy Gleason Score Gleason Grade Prostatectomy Specimen 
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