Latent Gleason Number 5.

[pjoshea13]

New Japanese study.

I don't know what percentage of U.S. men are diagnosed with Gleason score 4+5, 5+4 or 5+5, based on a biopsy, but in this Japanese cohort ~11% were 'GP5 positive'.

However, ~25% (!!!) were 'latent GP5' "absence of GP5 in the biopsy specimen, but presence of GP5 in the prostatectomy specimen".

{GP = Gleason pattern = Gleason number.}

So, over a third of the men harbored GP5 cells in their prostates. Presumably, this would include men where the GP5 cells were not numerous enough to lead to a GS of 9-10. But, again presumably, GP5 cells are nonetheless clinically relevant?

"CONCLUSION:

"Latent GP5 is an important prognostic factor that should be evaluated in patients with low- and intermediate-risk for prostate cancer before the initiation of treatment."

-Patrick

ncbi.nlm.nih.gov/pubmed/303...

Anticancer Res. 2018 Nov;38(11):6529-6535. doi: 10.21873/anticanres.13018.

Aggressive Cancer Behavior of Latent Gleason Pattern 5 in Prostatectomy Specimens.

Fujimura T1, Fukuhara H2, Yamada Y3, Taguchi S2, Sugihara T4, Niimi A3, Nakamura M3, Nakagawa T5, Igawa Y6, Homma Y6, Kume H3.

Author information

1

Department of Urology, Jichi Medical University, Tochigi, Japan [e-mail].

2

Department of Urology, Kyorin University, Tokyo, Japan.

3

Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

4

Department of Urology, Jichi Medical University, Tochigi, Japan.

5

Department of Urology, Teikyo University School of Medicine, Tokyo, Japan.

6

Department of Urology, Japan Red Cross Hospital, Tokyo, Japan.

Abstract

BACKGROUND/AIM:

The aim of this study was to demonstrate the clinical significance of latent Gleason pattern (GP) 5 occasionally found in prostatectomy specimens.

MATERIALS AND METHODS:

Patients (n=605) undergoing radical prostatectomy were classified into three groups according to the presence of GP5 in the biopsy or in the prostatectomy specimens: 'GP5 negative', absence of GP in both specimens 'latent GP5', absence of GP5 in the biopsy specimen, but presense of GP5 in the prostatectomy specimen, and 'GP5 positive', presense of GP in both specimens. The characteristics of these three groups were analyzed.

RESULTS:

There were 381 men in the GP5-negative group, 155 in the latent GP5 group, and 69 in the GP5-positive group. Low- or intermediate-risk for prostate cancer, latent GP5 and surgical margin positivity were independent predictors of biochemical recurrence (Hazard ratio (HR): 3.1, 5.8, respectively, p=0.001, 0.0002, respectively).

CONCLUSION:

Latent GP5 is an important prognostic factor that should be evaluated in patients with low- and intermediate-risk for prostate cancer before the initiation of treatment.

Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

KEYWORDS:

Biochemical recurrence; Gleason score; prognosis; prostate cancer; robot-assisted radical prostatectomy

PMID: 30396982 DOI: 10.21873/anticanres.13018

[AlanMeyer]

That's an interesting and not altogether surprising finding.

Whenever we're told about a biopsy result we get two numbers X+Y where X is supposedly the most predominant cell type and Y the next most predominant. But I've never heard of anyone being told that there was a third value found - although this study shows that, in fact, it's quite common to have an undiscovered or unreported third value and not uncommon (~25%) that it's a 5.

If a pathologist examines 1000 cells in a biopsy sample (I'm guessing that he doesn't examine them one at a time but runs his eye over the microscope slide, gathering an overall impression) and sees a few high Gleason cells, what should he do? Should he report them? I'm thinking that, if he did, it would indicate that aggressive treatment is desirable and should be pursued.

Does anyone know if high Gleason cells are reported even if they're only a small minority of the cells in the samples?

Alan

[jdm3 in reply to AlanMeyer]

Yes. It was not until several months after the RP that the MO said and "the tertiary 5 component could be a problem". Huh? That was the first I heard of it. I don't think there was a whole lot, but still a major concern.

I went and read the post-op pathology report and it was right there. My bad for not reading it earlier.

[Hazard in reply to AlanMeyer]

Hi Alan, my RP was in 2015. Post-op path report said that GS was 4+3, with a tertiary of 5.

No-one commented on this at the time, maybe nobody recognised the significance. Perhaps no surprise, in retrospect, that 3.5 yrs later I have advanced metastatic disease.

[AlanMeyer in reply to Hazard]

It looks like you and jdm3 both had the tertiary 5 noted on the post-op pathology report. If pathologists are finding these Gleason 5 cells on post-op, there must be at least some biopsy studies that also showed a tertiary 5. If so, I would think that would be important information to know, but I've not heard anyone say they were told a tertiary biopsy score.

As we so often learn, we've got to stay on top of our health ourselves.

Alan

[pjoshea13 in reply to AlanMeyer]

The word 'tertiary' has an interesting twist. If over 95% of the cells have the same pattern, that pattern is used for both the primary & secondary number, & so we get 3+3, 4+4 & 5+5. In these cases, a reported tertiary pattern is actually the true secondary pattern.

-Patrick

[pjoshea13 in reply to pjoshea13]

I see that PubMed has 15 hits for <prostate "tertiary gleason pattern 5">:

ncbi.nlm.nih.gov/pubmed/?te...

-Patrick