Patel AA et al. (2007) PSA failure following definitive treatment of prostate cancer having biopsy Gleason score 7 with tertiary Grade 5. JAMA 298: 1533–1538

The Gleason score is a well-established indicator of prognostic significance in patients with prostate cancer, but there is still debate about how best to treat men with a Gleason score of 7 (3+4 or 4+3) and a tertiary pattern of 5. The US International Society of Urologic Pathology has recommended that men with this Gleason score and pattern should have their cancer reclassified as Gleason score 8 or 9.

Patel et al. investigated the prognostic importance of Gleason score 7 with tertiary grade 5 compared with other Gleason scores in 2,370 men with clinical tumor category 1c–3b, node-negative, and nonmetastatic prostate cancer. Gleason scores were assigned and Cox regression analysis was used to judge whether there was a significant association between Gleason score and the rate of disease progression.

Men with a Gleason score 7 and tertiary grade 5 experienced prostate-specific antigen (PSA) failure significantly more quickly than did men with Gleason score 7 without tertiary grade 5 (median time 5.0years vs 6.7 years), and at a similar rate to men with Gleason score 8–10 (median time 5.1 years). Men with a Gleason score of 6 maintained low PSA levels for a significantly longer period (median time 15.4 years).

The authors conclude that it might be prudent to upgrade men with a Gleason score of 7 and a tertiary grade 5 to a higher level, and alter their treatment regimen accordingly.