Abstract Objectives This study aims to clarify the clinicopathological significance of several novel pathological markers, including the percentage of Gleason pattern 4 and small/non‐small cribriform pattern, in intermediate‐risk Gleason score 3 + 4 = 7 prostate cancer. Subjects and Methods Two‐hundred and twenty‐eight patients with Gleason score 3 + 4 = 7 intermediate‐risk prostate cancer who underwent radical prostatectomy between 2009 and 2019 at our institute were selected. Preoperative clinicopathological characteristics, including serum prostate‐specific antigen level, clinical T stage, percentage of cancer‐positive cores at biopsy, small/non‐small cribriform pattern, the highest percentage of Gleason pattern 4, the total length of Gleason pattern 4 and percentage of Gleason score 7 cores were examined in univariate/multivariate logistic regression analysis to determine their predictive value for postoperative adverse pathological findings, defined as an upgrade to Gleason score 4 + 3 = 7 or higher, pN1 or pT3b disease. Results Fifty‐four cases (23.7%) showed adverse pathological findings. Although a non‐small cribriform pattern, highest Gleason pattern 4 percentage and total length of Gleason pattern 4 were predictive of adverse pathological findings in univariate analysis, only the highest Gleason pattern 4 percentage was an independent predictive factor in multivariate analysis (odds ratio: 1.610; 95% confidence interval: 1.260–2.070; P = 0.0002). Conclusion The highest Gleason pattern 4 percentage was a potent predictive parameter for Gleason score 3 + 4 = 7 intermediate‐risk prostate cancer and should be considered in the risk classification scheme for prostate cancer.
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