Prostate Cancer With Tertiary Gleason Pattern 5 in Prostate Needle Biopsy
Bibliographic record
Abstract
Significance of tertiary Gleason pattern/grade 5 on prostatectomy has been studied, but its significance on biopsy remains uncertain. Recent International Society of Urological Pathology consensus conference recommended that biopsy Gleason score is generated by adding tertiary grade 5 to the primary grade. We examined the preoperative clinical and biopsy findings in 53 patients with biopsy tertiary pattern 5 and 119 patients with primary/secondary biopsy pattern 5. Prostatectomy findings and prostate-specific antigen (PSA) failure rates were compared in surgically treated patients. Cause-specific and all-cause mortality were compared in patients treated nonsurgically. At presentation, age, gland volume, PSA, and biopsy cancer volume were similar in patients with tertiary and primary/secondary grade 5. Only 20 patients underwent prostatectomy and 152 were treated nonsurgically. Regardless of the pattern, patients treated by prostatectomy were younger (P=0.003), had lower PSA (P=0.001), and less cancer on biopsy (P=0.0001). Prostatectomy findings and PSA failures were not significantly different in patients with tertiary grade 5 versus primary/secondary pattern 5. In nonsurgically treated patients, patients with primary pattern 5 compared with those with tertiary pattern 5 had a significantly higher risk of all-cause mortality [adjusted hazard ratio (HR): 2.33, 95% confidence interval (CI): 1.10-4.90, P=0.026] and cause-specific mortality (adjusted HR: 7.52, 95% CI: 2.84-19.87, P<0.001). In contrast, patients with secondary pattern 5 had a comparable all-cause mortality risk to patients with tertiary pattern 5 (adjusted HR: 1.04, 95% CI: 0.47-2.32, P=0.92), but had a marginally higher risk of cause-specific mortality than patients with tertiary pattern 5 (adjusted HR: 2.13, 95% CI: 0.75-6.10, P=0.16).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".