INTRODUCTION
Prostate adenocarcinoma is the most common cancer in men and the second
cause of mortality after lung cancer (1). The fact that the tumor has
different growth rates in different histopathological (HP) patterns and
its mortality is relatively low reveal the importance of the HP
examination in terms of treatment modalities.
The Gleason scoring system, which was first developed by Donald Gleason
in 1966 and universally accepted in 1974, has been updated over the
years, but is still valid today and is seen as the most valuable
prognostic parameter of prostate cancer (2–4). In recent studies, it
was found that the prognoses of scores such as 3+4 and 4+3, which have
the same sum but a different order of pattern frequencies, have been
found to be different and this system has been updated. The latest
classification which was published by the World Health Organization
(WHO) in 2016, includes a consensus approach between the WHO and The
International Urological Pathology Association (ISUP) after a meeting
which was held in 2014 (5,6). According to this consensus report,
Gleason score (GS) 2-5 were not included in this staging due to the
difficulty in diagnosis, tumors with a GS 3+3=6 were classified as Group
Grade (GG) I, tumors with 3+4=7 as GG II, tumors with 4+3=7 are
classified as GG III, tumors with 4+4=8, 3+5=8, and 5+3=8 as GG IV and
GS 9-10 are classified as GG V (6–8).
In addition to the GS, the HP parameters that are thought to affect
prognosis include extraprostatic extension (EPE), surgical margin
positivity (SMP), perineural invasion (PNI), lymphovascular invasion
(LVI), seminal vesicle invasion (SVI), presence of a high-grade tertiary
pattern and high grade prostatic intraepithelial neoplasia (HGPIN).
While some of these have proven prognostic effects, some of them remain
to be controversial (9,10). Besides, studies are reporting that the
presence of cribriform type glands in the Gleason pattern 4 group has a
worse prognosis than other pattern 4 histological subtypes (11–14).
Prostate-specific antigen (PSA) values in blood are used to determine
the biochemical recurrence (BCR) in the postoperative period and it is
also important in evaluating treatment response (15,16). Patients with a
high GS are likely to show recurrence, but these criteria have not been
clearly defined (6,8).
Based on all these information and updates, we aimed to revise the HP
findings of radical prostatectomy (RP) materials according to the
WHO-ISUP 2016 classification, to determine the BCRs of these patients in
the postoperative period, and try to establish a correlation between the
recurrent patients and HP features, to compare the new classification
with the old one and to investigate the effects of the evaluated HP
features in terms of recurrence and prognosis.