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This systematic review has established the association of a tertiary grade with poorer outcome than that associated with no tertiary grade.
Several studies have investigated the clinical significance of a tertiary grade in radical prostatectomy samples.
Three studies correlated the presence of a tertiary grade with pathological stage, and six with prostate-specific antigen recurrence or clinical progression.
However, modification of the Gleason score to include a tertiary grade in Gleason 4+3 tumours might overestimate the risk of seminal-vesicle or lymph-node invasion.
A tertiary grade should, therefore, be included in the pathological reporting of prostate cancer and be considered in the interpretation and design of clinical trials.
In five studies the presence of a tertiary grade increased the risk of prostate-specific antigen recurrence after radical prostatectomy by a factor of 2·5.
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The handling of tertiary grades is of practical importance only with respect to grade 7 cancers.
A systematic search of the published work identified seven studies that reported the prognostic value of a tertiary Gleason grade.
Furthermore, because only about 50% proceed to tertiary education, Grade 12 English proficiency is seen as the end-product of Japanese formal English education.
The presence of a tertiary Gleason grade (TGG) pattern in radical prostatectomy (RP) specimens has been described as associated with adverse pathology and a higher biochemical recurrence (BCR) rate after RP.
$Tertiary Gleason grade 5. (KPS = Karnofsky Performance Status; GSS = Gleason Sum Score; iPSA = initial PSA value at diagnosis; nPSA = nadir PSA value prior to second TRUSS-guided biopsy; PFS = biochemical progression-free survival; N/P = not yet progressed).
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CEO of Professional Science Editing for Scientists @ prosciediting.com