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• W1998118468 abstract "No AccessJournal of UrologyReview Article1 Feb 2010An Update of the Gleason Grading System Jonathan I. Epstein Jonathan I. EpsteinJonathan I. Epstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.10.046AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: An update is provided of the Gleason grading system, which has evolved significantly since its initial description. Materials and Methods: A search was performed using the MEDLINE® database and referenced lists of relevant studies to obtain articles concerning changes to the Gleason grading system. Results: Since the introduction of the Gleason grading system more than 40 years ago many aspects of prostate cancer have changed, including prostate specific antigen testing, transrectal ultrasound guided prostate needle biopsy with greater sampling, immunohistochemistry for basal cells that changed the classification of prostate cancer and new prostate cancer variants. The system was updated at a 2005 consensus conference of international experts in urological pathology, under the auspices of the International Society of Urological Pathology. Gleason score 2–4 should rarely if ever be diagnosed on needle biopsy, certain patterns (ie poorly formed glands) originally considered Gleason pattern 3 are now considered Gleason pattern 4 and all cribriform cancer should be graded pattern 4. The grading of variants and subtypes of acinar adenocarcinoma of the prostate, including cancer with vacuoles, foamy gland carcinoma, ductal adenocarcinoma, pseudohyperplastic carcinoma and small cell carcinoma have also been modified. Other recent issues include reporting secondary patterns of lower and higher grades when present to a limited extent, and commenting on tertiary grade patterns which differ depending on whether the specimen is from needle biopsy or radical prostatectomy. Whereas there is little debate on the definition of tertiary pattern on needle biopsy, this issue is controversial in radical prostatectomy specimens. Although tertiary Gleason patterns are typically added to pathology reports, they are routinely omitted in practice since there is no simple way to incorporate them in predictive nomograms/tables, research studies and patient counseling. Thus, a modified radical prostatectomy Gleason scoring system was recently proposed to incorporate tertiary Gleason patterns in an intuitive fashion. For needle biopsy with different cores showing different grades, the current recommendation is to report the grades of each core separately, whereby the highest grade tumor is selected as the grade of the entire case to determine treatment, regardless of the percent involvement. After the 2005 consensus conference several studies confirmed the superiority of the modified Gleason system as well as its impact on urological practice. Conclusions: It is remarkable that nearly 40 years after its inception the Gleason grading system remains one of the most powerful prognostic factors for prostate cancer. This system has remained timely because of gradual adaptations by urological pathologists to accommodate the changing practice of medicine. References 1 : The histology and prognosis of prostatic cancer. J Urol1967; 97: 331. 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Google Scholar Departments of Pathology, Urology and Oncology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, The Johns Hospital, Baltimore, Maryland© 2010 by American Urological AssociationFiguresReferencesRelatedDetailsCited byKirmiz S, Qi J, Babitz S, Linsell S, Denton B, Singh K, Auffenberg G, Montie J and Lane B (2019) Grade Groups Provide Improved Predictions of Pathological and Early Oncologic Outcomes Compared with Gleason Score Risk GroupsJournal of Urology, VOL. 201, NO. 2, (278-283), Online publication date: 1-Feb-2019.Saad F, Latour M, Lattouf J, Widmer H, Zorn K, Mes-Masson A, Ouellet V, Saad G, Prakash A, Choudhury S, Han G, Karakiewicz P and Richie J (2018) Biopsy Based Proteomic Assay Predicts Risk of Biochemical Recurrence after Radical ProstatectomyJournal of Urology, VOL. 197, NO. 4, (1034-1040), Online publication date: 1-Apr-2017.Ham W, Chalfin H, Feng Z, Trock B, Epstein J, Cheung C, Humphreys E, Partin A and Han M (2018) The Impact of Downgrading from Biopsy Gleason 7 to Prostatectomy Gleason 6 on Biochemical Recurrence and Prostate Cancer Specific MortalityJournal of Urology, VOL. 197, NO. 4, (1060-1067), Online publication date: 1-Apr-2017.Weiner A, Patel S, Etzioni R and Eggener S (2018) National Trends in the Management of Low and Intermediate Risk Prostate Cancer in the United StatesJournal of Urology, VOL. 193, NO. 1, (95-102), Online publication date: 1-Jan-2015.Tsao C, Gray K, Nakabayashi M, Evan C, Kantoff P, Huang J, Galsky M, Pomerantz M and Oh W (2018) Patients with Biopsy Gleason 9 and 10 Prostate Cancer Have Significantly Worse Outcomes Compared to Patients with Gleason 8 DiseaseJournal of Urology, VOL. 194, NO. 1, (91-97), Online publication date: 1-Jul-2015.Humphrey P (2018) Cribriform Adenocarcinoma of the ProstateJournal of Urology, VOL. 193, NO. 5, (1655-1656), Online publication date: 1-May-2015.Humphrey P, Hickey T, Riley T, Mabie J, Bellinger A, Strother M and Andriole G (2018) Modified Gleason Grade of Prostatic Adenocarcinomas Detected in the PLCO Cancer Screening TrialJournal of Urology, VOL. 192, NO. 2, (391-395), Online publication date: 1-Aug-2014.Bains L, Studer U, Froehlich J, Giannarini G, Triantafyllou M, Fleischmann A and Thoeny H (2018) Diffusion-Weighted Magnetic Resonance Imaging Detects Significant Prostate Cancer with High ProbabilityJournal of Urology, VOL. 192, NO. 3, (737-742), Online publication date: 1-Sep-2014.Mahmood U, Levy L, Nguyen P, Lee A, Kuban D and Hoffman K (2018) Current Clinical Presentation and Treatment of Localized Prostate Cancer in the United StatesJournal of Urology, VOL. 192, NO. 6, (1650-1656), Online publication date: 1-Dec-2014.Ellis C, Partin A, Han M and Epstein J (2018) Adenocarcinoma of the Prostate with Gleason Score 9-10 on Core Biopsy: Correlation with Findings at Radical Prostatectomy and PrognosisJournal of Urology, VOL. 190, NO. 6, (2068-2073), Online publication date: 1-Dec-2013.McKenney J, Simko J, Bonham M, True L, Troyer D, Hawley S, Newcomb L, Fazli L, Kunju L, Nicolas M, Vakar-Lopez F, Zhang X, Carroll P and Brooks J (2018) The Potential Impact of Reproducibility of Gleason Grading in Men With Early Stage Prostate Cancer Managed by Active Surveillance: A Multi-Institutional StudyJournal of Urology, VOL. 186, NO. 2, (465-469), Online publication date: 1-Aug-2011. (2018) Reply by AuthorsJournal of Urology, VOL. 183, NO. 5, (2100-2101), Online publication date: 1-May-2010. Volume 183Issue 2February 2010Page: 433-440 Advertisement Copyright & Permissions© 2010 by American Urological AssociationKeywordssurgical pathologycarcinomasmall cellprostatic neoplasmsprostateadenocarcinomaMetricsAuthor Information Jonathan I. Epstein More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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