Gleason score 7 prostate cancer: A heterogeneous entity? Correlation with pathologic parameters and disease-free survival

Objectives. Gleason score 7, in different proportions of grades 3 and 4, is the score most frequently assigned to prostate cancer in our radical prost atectomy specimens (RPSs). We correlated the major grade component of score 7 tumors with clinicopathologic parameters and disease-free survival. Methods. All Gleason score 7 RPSs were classified as having a major grade o f 3 or 4 carcinoma. The two groups were compared according to patient age, race, serum prostate-specific antigen (PSA) level, clinical and pathologic stage, tumor volume, and biochemical recurrence. Results. Of the 534 patients analyzed, 356 and 178 had major grade 3 or 4 t umors, respectively. Compared with patients with 3+4 tumors, those with 4+3 had significantly more advanced clinical and pathologic stages, larger tum or volume, higher preoperative PSA levels, and older age and a higher propo rtion were African American (P <0.05 for all above parameters). With a mean follow-up of 34.6 months, patients with 3+4 tumors experienced lower rates of PSA recurrence than did those with 4+3 tumors (P = 0.0021). Furthermore , for the subset of patients with organ-confined disease, multivariable ana lysis that included race, age, clinical stage, preoperative PSA level, tumo r volume, and major grade component found only the latter to be a significa nt predictor of recurrence, with patients who had major grade 4 component t umors experiencing a higher incidence of PSA recurrence than those with maj or grade 3 tumors (P = 0.012). Conclusions. The major grade 4 component in Gleason score 7 carcinoma indic ates a higher likelihood of biochemical recurrence, particularly for the in creasing proportion of patients with organ-confined disease after radical p rostatectomy. UROLOGY 56: 730-734, 2000. (C) 2000, Elsevier Science Inc.