Prostate cancer (PCa) survival differs by specific Gleason grade group (GG) 5 pattern, according to a new study.

Men with Gleason pattern 5+4 and 5+5 had significantly increased risks for cancer-specific mortality (CSM) compared with those with Gleason pattern 4+5.

“Ideally, individual Gleason patterns should be considered in pretreatment risk stratification,” Mike Wenzel, MD, of the University Hospital Frankfurt in Germany and colleagues concluded in a paper published in European Urology Focus.

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Using the 2004-2016 data from the Surveillance, Epidemiology and End Results (SEER) database, the investigators identified 17,263 men with GG 5 cancer at biopsy, including 12,705 with Gleason 4+5, 3302 with Gleason 5+4, and 1256 with Gleason 5+5 disease. All patients underwent radical prostatectomy (RP) or external beam radiation therapy (EBRT).

The 5- and 10-year CSM rates were 7.3% and 18.2% for Gleason 4+5, 11.7% and 28.0% for Gleason 5+4, and 19.8% and 39.1% for Gleason 5+5, respectively, Dr Wenzel and his colleagues reported.

In multivariable analyses, Gleason 5+4 and Gleason 5+5 were associated with 1.6- and 2.2-fold higher CSM risks, respectively, compared with Gleason 4+5. The risks varied by treatment subgroup. Compared with Gleason 4+5, Gleason 5+4 was significantly associated with approximately 1.6- and 2.5-fold increased CSM risks among patients who underwent RP and EBRT, respectively. Gleason 5+5 was significantly associated with approximately 1.5- and 2.1-fold increased risks, respectively.

Investigators adjusted for age at diagnosis, PSA at diagnosis, clinical stage, and lymph node status.

“Prostate cancer characteristics were increasingly unfavorable with increasingly aggressive Gleason pattern from 4+5 to 5+4 to 5+5,” Dr Wenzel’s team observed. They noted that the death risk associated with Gleason pattern 5+5 cancer was even higher for patients undergoing RP than EBRT, perhaps partly due to use of androgen deprivation therapy.


Wenzel M, Würnschimmel C, Chierigo F, et al. Pattern of biopsy Gleason grade group 5 (4 + 5 vs 5 + 4 vs 5 + 5) predicts survival after radical prostatectomy or external beam radiation therapy. Eur Urol Focus. Published online April 28, 2021. doi:10.1016/j.euf.2021.04.011