{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:36:17Z","timestamp":1791221777545,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100018722","name":"Jaap Schouten Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018722","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Gleason grading system for prostate cancer (PCa) is based on the proportions of Gleason patterns (GP) 3\u20135. While pure GP3 has minimal metastatic potential, it is unclear whether GP3 quantity in the presence of GP4 and GP5 affects oncological outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the predictive value of PCa biopsy GP lengths on long\u2010term metastasis\u2010free survival (MFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prostate biopsies of 1,881 men with screen\u2010detected PCa who participated in the Dutch part of the European Randomized Study of Screening for Prostate Cancer (ERSPC) between 1993 and 2007 were revised for GP 3\u20135 length. Multivariable Cox regression analyses were used to evaluate the relationship between GP lengths and MFS truncated at 20\u2009years, adjusting for clinical\u2010tumour stage (cT), prostate\u2010specific antigen (PSA), percentage positive biopsies and the presence of invasive cribriform\/intraductal carcinoma (CR\/IDC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results and limitations<\/jats:title>\n                    <jats:p>\n                      On multivariable analysis, \u2265cT2, PSA, percentage positive cores and absolute length of GP4 and GP5 were all significantly associated with MFS. The discriminative ability was improved by adding CR\/IDC to the model. Total GP3 length was neither associated with MFS in the model with (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.97\u20131.00,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.3) nor without CR\/IDC (HR 0.98, 95% CI 0.96\u20131.01,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.2). A limitation is the lack of targeted biopsies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and clinical implications<\/jats:title>\n                    <jats:p>GP3 length does not have an impact on the prediction of MFS in biopsies, once GP4\/GP5 lengths are known. Although GP3 percentage is essential in Gleason grading, MFS is related to absolute GP4 and GP5 quantity rather than their proportion to GP3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.70052","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T10:21:36Z","timestamp":1764152496000},"page":"881-888","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Rethinking Gleason pattern quantification in predicting metastasis: results of 20\u2009years of follow\u2010up in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6801-3633","authenticated-orcid":false,"given":"Lisa J","family":"Kroon","sequence":"first","affiliation":[{"name":"Department of Pathology Erasmus MC Cancer Institute, University Medical Centre  Rotterdam The 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F","family":"Kweldam","sequence":"additional","affiliation":[{"name":"Department of Pathology Maasstad Hospital  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6672-1343","authenticated-orcid":false,"given":"L Lucia","family":"Rijstenberg","sequence":"additional","affiliation":[{"name":"Department of Pathology Erasmus MC Cancer Institute, University Medical Centre  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2605-2453","authenticated-orcid":false,"given":"Roderick C N","family":"van\u00a0den Bergh","sequence":"additional","affiliation":[{"name":"Department of Urology Erasmus MC Cancer Institute, University Medical Centre  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6967-1708","authenticated-orcid":false,"given":"Monique 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