Prognostic Implications for Patients with Gleason Tertiary Pattern 5 Prostate Cancer

The Gleason scoring system is the most widely used method for grading prostate cancer tumors; it involves assessing the architectural patterns of prostate gland biopsy specimens under low-power magnification. The Gleason score is a sum of the grade (range, 1–5) for the primary pattern of the tumor (i.e., differentiation stage of most tumor cells) and the grade for the secondary pattern (i.e., differentiation stage of a minority of cells). Gleason scores range from 2 to 10, with higher Gleason scores indicating more-aggressive tumors. During the past several years, pathologists increasingly have commented on the presence of “tertiary” patterns in smaller numbers of cells. Some evidence has emerged showing that even a small proportion of tumo…