Does tertiary Gleason score 5 have prognostic significance in men with prostate cancer?
Jonathan I Epstein
Correspondence Johns Hopkins Hospital, 401 N. Broadway Street, Rm 2242, Baltimore, MD 21231, USA
Email jepstein@jhmi.edu
This article has no abstract so we have provided the first paragraph of the full text.
In 1966, Donald F Gleason created a unique grading system for prostatic carcinoma.1 Rather than assigning the worst grade as the overall grade of the carcinoma, the Gleason score was defined as the sum of the two most common grade patterns. Issues with this system arose over the subsequent 40 years, including how to grade specimens with tertiary patterns. Several studies have demonstrated the importance of tertiary grades in radical prostatectomy specimens;2 however, the significance of tertiary patterns varies depending on the primary, secondary, and tertiary grades. For example, Gleason score 3 + 4 = 7 with tertiary pattern 5 is similar in prognosis to Gleason score 3 + 5 = 8; however, Gleason score 4 + 3 = 7 with tertiary pattern 5 does not have the same prognosis as Gleason score 4 + 5 = 9.
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