The significance of tertiary Gleason pattern in prostate cancer

Abstract

Aim: Prostate cancer has a heterogenous nature and to have better prognostic prediction the prognostic importance of tertiary Gleason pattern (TGP) is debated today. Although the prognostic significance of TGP is accepted by the urology era, it is still not routinely included in pathological reports at most centers and it is not practically viable in predictive nomograms and patient counselling. The description of TGP and its prognostic affect is tried to be summarised in this article. New Findings: At radical prostatectomy (RP) specimens a frequency of 20 to 30% was reported in literature for TGP. As the Gleason score increases there is increased risk of having TGP. In RP patients the presence of a TGP has a negative impact on pathological prognostic factors like extraprostatic extension, seminal vesicle invasion, lymph node invasion and surgical margin positivity. TGP has been shown to be an independent factor for biochemical free survival in lots of studies. Conclusion: TGP has a strong impact on prognostic prediction after RP and must be reported routinely in pathology results. It increases the toal Gleason score and clinical decisions must be refined in the case of TGP presence. Further studies are required for the understanding of TGP in Gleason system and for its viability in predictive nomograms and utilisation in clinical decision making.