Objective: To study the prognostic influence of tertiary pattern 5 (TP5) in radical prostatectomy specimens with a Gleason score of 7. Materials and Methods: A total of 4060 specimens with a Gleason score of 7 with and without TP5 seen between 2005 and 2015 were retrospectively reviewed. Cases were subdivided into 3 + 4 = 7, 3 + 4 = 7 with TP5, 4 + 3 = 7, and 4 + 3 = 7 with TP5. We compared prostate-specific antigen, clinical stage, pathologic stage, and surgical margin status between the groups. The impact of TP5 on biochemical recurrence was also assessed. Results: The median age was 68 years old with a median prostate-specific antigen level of 9.3 ng/mL. TP5 was present in 259 patients (6.4%) with a Gleason score 3 + 4 = 7 and in 361 patients (8.9%) with a Gleason score of 4 + 3 = 7. The mean follow-up without progression was 3 years. The presence of a tertiary pattern correlated with pathologic stage; the only exception was that there was no statistically significant difference between Gleason score 3 + 4 = 7 with TP5 and 4 + 3 = 7. Multivariate analysis showed that TP5 was independently associated with biochemical recurrence among patients with a Gleason score of 7 (P < .001). There was no difference between 3 + 4 = 7 with TP5 and 4 + 3 = 7 in terms of biochemical recurrence-free survival rate (P = .4). Conclusion: The impact of TP5 of Gleason score 7 in radical prostatectomy specimens is still significant using contemporary grading. Moreover, TP5 was independently associated with biochemical recurrence. However, 3 + 4 = 7 with TP5 behaves like 4 + 3 = 7 in terms of biochemical recurrence-free survival rate.
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