Meaning of "tertiary" pattern?

If you edit your post and add a subject, someone will chime in with your answer. Welcome aboard!

It means a third, higher Gleason grade cancer occupies less than 5% of the cancer in the biopsy core, or of the tumor examined by the pathologist. It raises the risk level of the Gleason score.

The primary Gleason grade occupies ≥50%, the secondary Gleason grade occupies 5-49%

What I said comes from Wikipedia, which may be incorrect. I assumed it was Gleason's original design, but they don't provide a reference.

Wikipedia said...
Primary, secondary and tertiary grades
A pathologist then assigns a grade to the observed patterns of the tumor specimen.

Primary grade - assigned to the dominant pattern of the tumor (has to be greater than 50% of the total pattern seen).

Secondary grade - assigned to the next-most frequent pattern (has to be less than 50%, but at least 5%, of the pattern of the total cancer observed).

Tertiary grade - increasingly, pathologists provide details of the "tertiary" component. This is where there is a small component of a third (generally more aggressive) pattern.

As to how to score the example you gave, you are partly right (according to Epstein). What you say seems to be true for pathology, but not for biopsy.

The way I understand it for biopsy is that if there are 3 significant components, the most prevalent grade and the highest grade are both reported, and the secondary grade is ignored. So, in your example, it would be reported as Gleason 3+5. Tertiary components have to be higher grade and not lower grade (which would be ignored).

Epstein said...
The consensus of the group was that on needle biopsies with patterns 3, 4, and 5, both the primary pattern and the highest grade should be recorded . Consequently, tumors with Gleason score 3 + 4 and a tertiary pattern 5 would be recorded as Gleason score 3 + 5 = 8. In cases where there are three patterns consisting of patterns 2, 3, and 4, it was the consensus of the group that one would ignore the pattern 2 and the biopsy would be called Gleason score 3 + 4 = 7 or Gleason score 4 + 3 = 7, depending on whether pattern 3 or pattern 4 was more prevalent.

But he agrees with you about post-RP pathology:

Epstein said...
On radical prostatectomy specimens, it would be misleading to derive the Gleason score by adding the most common Gleason pattern and the highest Gleason pattern. It was the consensus of the group that for a radical prostatectomy specimen one assigns the Gleason score based on the primary and secondary patterns with a comment as to the tertiary pattern

Thanks for pointing that out.

- Allen

I was diagnosed as GL9 (4+5) so was scheduled for radiation even before my surgery was undertaken.

Following surgery the pathology revised that to GL 7 (4+3) with Teriary 5 (5%). Because it had escaped the capsule, the RT went ahead, as did adj ADT.

I felt some relief at the lower reading, and even though the RT has left me with some permanent impairment, I am still glad I went through that process.

With any 5 anywhere and for any amount, I think you have to hit it hard, and we did that. I won't ever be left wondering what if....I know we did all that could be done, in spite of the side effects.

Wishing you all the best,

Chas

I agree that it feels good to take some positive action, even if it accomplishes nothing - as long as it's mostly harmless and cheap. Low dose aspirin, statins, and metformin probably will do no harm. The supplements of interest that haven't been disproven yet are soy isoflavones and sulforaphane. I'd continue to avoid antioxidants - your immune system needs reactive oxygen species to kill cancer.

- Allen

ed-
I invite you to re-read what I wrote without your filters that obviously led to misinterpretation. There is nothing sarcastic or condescending about it. It's honest advice that I take myself. It's all part of patient empowerment in the face of uncertainty.
- Allen