Grading of prostatic adenocarcinoma: current state and prognostic implications.

Jennifer Gordetsky,Jonathan Epstein

doi:10.1186/s13000-016-0478-2

Jennifer Gordetsky, Jonathan Epstein

Open Access

https://doi.org/10.1186/s13000-016-0478-2

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Abstract

BackgroundDespite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient’s prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care.Main BodyWe describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10.ConclusionAs this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.

Highlights

Gleason grading Gleason grading of prostatic adenocarcinoma can typically be performed using the 4x objective, there may be certain instances that require higher magnification at 10xGordetsky and Epstein Diagnostic Pathology (2016) 11:25The current application of the Gleason grading system is significantly different from the original version
The Gleason grading system is based on a study from 1959 through 1964 by the Veteran’s Affairs Cooperative Research Group (VACURG), which enrolled 270 men with prostate cancer [1]
We describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma [2, 3]

Summary

Background

The Gleason grading system is based on a study from 1959 through 1964 by the Veteran’s Affairs Cooperative Research Group (VACURG), which enrolled 270 men with prostate cancer [1]. Dr Donald Gleason, the Chief of Pathology at the Veteran’s Hospital in Minnesota, created a grading system for prostate cancer based on its different histologic patterns. Despite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. This system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care. We explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score [4, 5]

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