Prognosis among men with prostate cancer is associated with the Gleason score, which is based on assignment of a grade of 1 to 5 to the predominant and second most prevalent histologic patterns. A higher grade denotes less differentiation. Some pathologists also assign a tertiary pattern grade, but the relationship of the tertiary pattern to prognosis is not clear. In a cohort of men with node-negative, nonmetastatic and definitively treated biopsy Gleason score 7 prostate cancer, Patel and colleagues assessed whether there is an association between time to biochemical recurrence (prostate-specific antigen [PSA] failure) and the presence or absence of tertiary grade 5 disease. The authors found that men with tertiary grade 5 had a median time to PSA failure of 5.0 years, whereas men without tertiary grade 5 had a median time to PSA failure of 6.7 years.