Gleason Pattern 5 is a Possible Pathologic Predictor for Biochemical Recurrence after Laparoscopic Radical Prostatectomy

Document Type : Research Articles


Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.


Objective: Several prognostic factors for biochemical recurrence after radical prostatectomy have been reported,
including initial prostate-specific antigen level, Gleason score, positive surgical margin, and seminal vesicle invasion.
Here we investigate whether Gleason pattern 5 is a predictor for biochemical recurrence. Methods: This retrospective
study included 168 patients who underwent laparoscopic radical prostatectomy from 2006 to 2015. The relationship
between biochemical recurrence after laparoscopic radical prostatectomy and the presence of Gleason pattern 5, even
as a tertiary pattern, was investigated. Biochemical recurrence was defined when the prostate-specific antigen level
rose to >0.2 ng/ml after having decreased to recurrence-free survival was estimated by the Kaplan-Meier method. Multivariate analysis was performed using a
Cox proportional hazards regression model. Results: The median age was 66 years, median initial prostate-specific
antigen level was 6.9 ng/ml, and median follow-up period was 47.3 months. Biochemical recurrence was recognized
in 27 patients (16.1%) after laparoscopic radical prostatectomy, and 5-year biochemical recurrence-free survival was
78.6%. Gleason pattern 5 was noted in 5 patients as the primary pattern, in 10 as the secondary pattern, and in 5 as the
tertiary pattern. According to multivariate analysis, presence of Gleason pattern 5 (HR = 4.75, p=0.001) and positive
surgical margin (HR = 4.66, p=0.001) were independent predictive factors for biochemical recurrence-free survival.
Conclusion: Gleason pattern 5 appears to be an important predictive factor for biochemical recurrence after laparoscopic
radical prostatectomy.


Main Subjects