Peer-Reviewed Literature

Editorial: Replace Gleason with pattern 4 quantification

  • Replacing the Gleason score with pattern 4 quantification
    Vickers AJ, Fine SW. Three Things About Gleason Grading That Just About Everyone Believes But That Are Almost Certainly Wrong. Urology. 2020 Sep;143:16-19. doi: 10.1016/j.urology.2020.03.042. Epub 2020 Apr 15. PMID: 32304682.

Pattern 4 Quantification is highly prognostic

  • Length of pattern 4 predicts adverse surgical pathology in men with grade group 2 prostate cancer
    Dean LW, Assel M, Sjoberg DD, et al. Clinical Usefulness of Total Length of Gleason Pattern 4 on Biopsy in Men with Grade Group 2 Prostate Cancer. J Urol. 2019;202(2):309-316. doi:10.1016/j.juro.2018.07.062

  • Length of pattern 4 predicts biochemical recurrence in men with grade group 2 prostate cancer
    Perera M, Assel MJ, Benfante NE, et al. Oncologic Outcomes of Total Length Gleason Pattern 4 on Biopsy in Men with Grade Group 2 Prostate Cancer. J Urol. 2022;208(2):309-316. doi:10.1097/JU.0000000000002685

  • Pattern 4 in men on active surveillance: upgrading is questionable endpoint
    Perera M, Assel M, Nalavenkata S, Khaleel S, Benfante N, Carlsson SV, Reuter VE, Laudone VP, Scardino PT, Touijer KA, Eastham JA, Vickers AJ, Fine SW, Ehdaie B. Quantification of Gleason Pattern 4 Metrics Identifies Pathologic Progression in Patients With Grade Group 2 Prostate Cancer on Active Surveillance. Clin Genitourin Cancer. 2024 Dec;22(6):102204. doi: 10.1016/j.clgc.2024.102204. Epub 2024 Aug 14. PMID: 39260095.

  • Pattern 4 volume best predictor of PSA
    Andolfi C, Vickers AJ, Cooperberg MR, Carroll PR, Cowan JE, Paner GP, Helfand BT, Liauw SL, Eggener SE. Blood Prostate-specific Antigen by Volume of Benign, Gleason Pattern 3 and 4 Prostate Tissue. Urology. 2022 Dec;170:154-160. doi: 10.1016/j.urology.2022.08.014. Epub 2022 Aug 17. PMID: 35987380; PMCID: PMC10515713.

  • Pattern 4 volume best predictor of advanced pathologic stage
    Scuderi S, Tin AL, Klug J, et al. The Absolute Volume of Gleason Pattern 4 on Radical Prostatectomy Is More Strongly Associated With Advanced Stage and Biochemical Recurrence Than Gleason Grade Groups. J Urol. 2024. doi:10.1097/JU.0000000000004484

  • Pattern 4 and 5 volume best predictor of distant metastasis
    Thomas Bommelaere, Arnauld Villers, Philippe Puech, Guillaume Ploussard, Julien Labreuche, Elodie Drumez, Xavier Leroy, Jonathan Olivier, Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy, European Urology Open Science,2022,https://doi.org/10.1016/j.euros.2022.04.011.

Findings best explained by pattern 4 volume being prognostic

  • Tumor volume assessed on MRI prognostic
    Yang DD, Lee LK, Tsui JMG, Leeman JE, McClure HM, Sudhyadhom A, Guthier CV, Taplin ME, Trinh QD, Mouw KW, Martin NE, Orio PF, Nguyen PL, D’Amico AV, Shin KY, Lee KN, King MT. AI-derived Tumor Volume from Multiparametric MRI and Outcomes in Localized Prostate Cancer. Radiology. 2024 Oct;313(1):e240041. doi: 10.1148/radiol.240041. PMID: 39470422.

  • Clinical low risk cancer at low risk of recurrence even if upgraded at radical prostatectomy
    Imnadze M, Sjoberg DD, Vickers AJ. Adverse Pathologic Features at Radical Prostatectomy: Effect of Preoperative Risk on Oncologic Outcomes. Eur Urol. 2016 Jan;69(1):143-8. doi: 10.1016/j.eururo.2015.03.044. Epub 2015 Apr 23. PMID: 25913389; PMCID: PMC4618775.

  • Clinical low risk cancer at low risk of metastasis even if upgraded at radical prostatectomy
    Kovac E, Vertosick EA, Sjoberg DD, Vickers AJ, Stephenson AJ. Effects of pathological upstaging or upgrading on metastasis and cancer-specific mortality in men with clinical low-risk prostate cancer. BJU Int. 2018 Dec;122(6):1003-1009. doi: 10.1111/bju.14418. Epub 2018 Jun 22. PMID: 29802773; PMCID: PMC6737926.

  • MRI finds tumors in men with negative biopsy that are not aggressive
    Vickers AJ. Effects of Magnetic Resonance Imaging Targeting on Overdiagnosis and Overtreatment of Prostate Cancer. Eur Urol. 2021 Nov;80(5):567-572. doi: 10.1016/j.eururo.2021.06.026. Epub 2021 Jul 20. Erratum in: Eur Urol. 2022 Sep;82(3):e89. doi: 10.1016/j.eururo.2022.05.022. PMID: 34294510; PMCID: PMC8530856.

  • Risk is intermediate when biopsy and pathologic grade group are discordant
    Scuderi S, Pellegrino F, Tin A, Beech BB, Gandaglia G, Stabile A, Eastham JA, Montorsi F, Briganti A, Vickers AJ. The Highest Grade Group Does Not Drive the Risk of Recurrence when Systematic and Multiparametric Magnetic Resonance Imaging (MRI)-targeted Biopsies are Discordant: Preliminary Findings Using Radical Prostatectomy Pathology as a Surrogate for MRI-targeted Biopsy Grade. Eur Urol Focus. 2024 May;10(3):486-488. doi: 10.1016/j.euf.2023.07.011. Epub 2023 Sep 20. PMID: 37739916; PMCID: PMC10950835.

  • Risk is intermediate when systematic and MRI-targeted grade group are discordant
    Gaffney CD, Tin AL, Fainberg J, Fine S, Jibara G, Touijer K, Eastham J, Scardino P, Laudone V, Vickers AJ, Ehdaie B. The oncologic risk of magnetic resonance imaging-targeted and systematic cores in patients treated with radical prostatectomy. Cancer. 2023 Dec 1;129(23):3790-3796. doi: 10.1002/cncr.34981. Epub 2023 Aug 16. PMID: 37584213; PMCID: PMC11249356.

Variation in Pattern 4 Quantification

  • Variability in tumor extent by different pathologists
    Bernhardt M, Weinhold L, Bremmer F, Chan E, Cheng L, Collins K, Downes M, Greenland N, Hommerding O, Iczkowski KA, Jufe L, Kreft T, van Leenders G, Oxley J, Perry-Keene J, Reis H, Schmid M, Tsuzuki T, Wobker S, Wiliamson SR, Kweldam C, Kristiansen G. Unexpectedly high variability in determining tumour extent in prostatic biopsies: implications for active surveillance. Histopathology. 2025 Mar;86(4):627-639. doi: 10.1111/his.15372. Epub 2024 Nov 28. PMID: 39610035; PMCID: PMC11791730.

  • Variability in pattern 4 volume between pathologists at two separate institutions
    Andolfi C, Vickers AJ, Cooperberg MR, Carroll PR, Cowan JE, Paner GP, Helfand BT, Liauw SL, Eggener SE. Blood Prostate-specific Antigen by Volume of Benign, Gleason Pattern 3 and 4 Prostate Tissue. Urology. 2022 Dec;170:154-160. doi: 10.1016/j.urology.2022.08.014. Epub 2022 Aug 17. PMID: 35987380; PMCID: PMC10515713.

Pattern 3 Not Predictive When Pattern 4 Known