Grading of prostatic cancer: II. The prognostic significance of the presence of multiple architectural patterns

Abstract

This second report in a series of three deals with the prognostic importance of the presence of multiple, histologically identifiable architectural patterns in prostatic carcinomas. In the previous paper three of 12 parameters studied were identified as being prognostically significant in patients with single architectural patterns (formations) present in their tumors. The three parameters are nuclear anaplasia, architecture (“glands”), and mitoses, if present. The questions of whether “the worst part of a tumor determines prognosis” or “the presence of differentiated formations improves prognosis” are investigated by applying these parameters to patients with multiple tumor formations. Overall and corrected survival served as parameters. It was shown that the parameters shown to be of importance for prognosis in tumors with single formations also have significant influence in patients with multiple formations. The worst formation determines prognosis, but patients with poorly differentiated tumors do significantly worse if their tumor is homogeneous. The presence of better-differentiated formations improves the prognosis of the worst formation. The observations made are discussed in view of the histopathogenesis of prostatic cancer.