Among prostate cancer patients with Gleason score (GS) 7 disease at radical prostatectomy, those with tertiary Gleason pattern 5 are more likely to experience biochemical recurrence (BCR) than those without tertiary pattern 5, a study found.

In a study of 350 radical prostatectomy patients with GS 3+4 or 4+3 disease, BCR risk was twice as high in patients with tertiary Gleason pattern 5, Lu Yang, MD, PhD, and colleagues of West China Hospital of Sichuan University, and colleagues reported in OncoTargets and Therapy. The effect of tertiary Gleason Pattern 5 in GS 4+3 disease was significantly stronger than in GS 3+4. BCR risk was 2.5-fold higher in men with primary Gleason pattern 4 disease and tertiary Gleason pattern 5. In the Cox proportional-hazards models, the team controlled for confounders, including surgical approach, age at surgery, body mass index, preoperative PSA, neoadjuvant hormone therapy, positive surgical margin, and tumor node metastasis stage.

Although the relevance of tertiary Gleason pattern 5 to more advanced prostate cancer has reached consensus, its relevance to BCR is still controversial, Dr Yang’s team explained. “The evidence, including this study, suggests that the current Gleason grading system should be updated to include TGP5 [tertiary Gleason pattern 5].” Further studies with larger sample sizes are needed to fully test these associations, they added.

Continue Reading

Related Articles


Li J, Guo Y, Qiu S, et al. Significance of tertiary Gleason pattern 5 in patients with Gleason score 7 after radical prostatectomy: a retrospective cohort study. OncoTargets Therap. 2019:12 7157–7164