Prostate Cancer Grading System Research Articles

Artificial intelligence unravels interpretable malignancy grades of prostate cancer on histology images

Malignancy grading of prostate cancer (PCa) is fundamental for risk stratification, patient counseling, and treatment decision-making. Deep learning has shown potential to improve the expert consensus for tumor grading, which relies on the Gleason score/grade grouping. However, the core problem of interobserver variability for the Gleason grading system remains unresolved. We developed a novel grading system for PCa and utilized artificial intelligence (AI) and multi-institutional international datasets from 2647 PCa patients treated with radical prostatectomy with a long follow-up of ≥10 years for biochemical recurrence and cancer-specific death. Through survival analyses, we evaluated the novel grading system and showed that AI could develop a tumor grading system with four risk groups independent from and superior to the current five grade groups. Moreover, AI could develop a scoring system that reflects the risk of castration resistant PCa in men who have experienced biochemical recurrence. Thus, AI has the potential to develop an effective grading system for PCa interpretable by human experts.

A deep learning network for Gleason grading of prostate biopsies using EfficientNet.

The most crucial part in the diagnosis of cancer is severity grading. Gleason's score is a widely used grading system for prostate cancer. Manual examination of the microscopic images and grading them is tiresome and consumes a lot of time. Hence to automate the Gleason grading process, a novel deep learning network is proposed in this work. In this work, a deep learning network for Gleason grading of prostate cancer is proposed based on EfficientNet architecture. It applies a compound scaling method to balance the dimensions of the underlying network. Also, an additional attention branch is added to EfficientNet-B7 for precise feature weighting. To the best of our knowledge, this is the first work that integrates an additional attention branch with EfficientNet architecture for Gleason grading. The proposed models were trained using H&E-stained samples from prostate cancer Tissue Microarrays (TMAs) in the Harvard Dataverse dataset. The proposed network was able to outperform the existing methods and it achieved an Kappa score of 0.5775.

Automated prostate cancer grading and diagnosis system using deep learning-based Yolo object detection algorithm

Purpose:Developing an artificial intelligence-based prostate cancer detection and diagnosis system that can automatically determine important regions and accurately classify the determined regions on an input biopsy image. Method:The Yolo general-purpose object detection algorithm was utilized to detect important regions (for the localization task) and to grade the detected regions (for the classification task). The algorithm was re-trained with our prostate cancer dataset. The dataset was created by annotating 500 real prostate tissue biopsy images. The dataset was split into train/test parts as 450/50 real prostate tissue images, respectively, before the data augmentation process. Next, the training set consisting of 450 labeled biopsy images was pre-processed with the data augmentation method. This way, the number of biopsy images in the dataset was increased from 450 to 1776. Then, the algorithm was trained with the dataset and the automatic prostate cancer detection and diagnosis tool was developed. Results:The developed tool was tested with two test sets. The first test set contains 50 images that are similar to the train set. Hence, 97% detection and classification accuracy has been achieved. The second test set contains 137 completely different real prostate tissue biopsy images, thus, 89% detection accuracy has been achieved. Conclusion:In this study, an automatic prostate cancer detection and diagnosis tool was developed. The test results show that high-accuracy (high-performance) prostate cancer diagnosis tools can be developed using AI (computer vision) methods such as object detection algorithms. These systems can decrease the inter-observer variability among pathologists, and help prevent the time delay in the diagnosis phase.

Histopathological differences based on method of biopsy: comparison between needle and radical prostatectomy

Background: Prostate cancer is the second most common male cancer. Prostate cancer is diagnosed via a digital rectal exam, ultrasonography, and serum prostate specific antigen. Dr. Donald Gleason devised a prostate cancer grading system over 50 years ago. This system is still viable with modifications. The ISUP updated in 2005 and 2015. Gleason score and prognosis in prostatectomy stuff Gleason score, tumor volume, and tumor laterality were compared. nephroscopy and prostate Method: The study comprised 42 men with biopsy and prostatectomy materials. Gleason's grade. The new method graded tumors. Between october2019 and October 2021, 42 individuals with prostate cancer were needle biopsy diagnosed and treated with RP. Tumor volume was measured by the number of positive blocks. A significant difference in diagnosed by digital imaging, serum prostate specific antigen, and needle biopsy. Gleason score, location, and volume are unknown tumor features. Result: Gleason score, tumor volume, and laterality between needle biopsy and prostatectomy materials Gleason score and tumor volume enhanced concordance. Conclusion: For a prostate cancer diagnosis, a digital exam, serum PSA and needle biopsy are quite sensitive. Lesser known tumor characteristics include Gleason score, location, and volume. Keywords: Prostate, Adenocarcinoma, Needle biopsy, Radical prostatectomy, Gleason score

What is the consistency between the results of needle biopsy and prostatectomy specimen pathology results? A pilot study

Background/aim The aim of this study was to establish the relationship between the needle biopsy and the pathology result after radical prostatectomy administrated for prostate cancer. Materials and methods We retrospectively analyzed 67 patients who had undergone radical prostatectomy from 2016 to 2019. All surgeries and all biopsies were performed in the third author’s urology department. Samples were collected through 12-core biopsy under local anesthesia. All specimens were studied in the pathology department of the third author’s center. The results evaluated were needle biopsies’ Gleason scores and prostatectomy specimens’ Gleason scores.Results Inclusion criteria were not having any neo-adjuvant treatment and being treated with surgery after needle biopsy. Gleason scores obtained from needle biopsies and prostatectomy specimens were evaluated. The comparison revealed that 39% of the tumors were undergraded, 7% were overgraded, and 54% had exact scoring in needle biopsies and prostatectomy specimens according to the detailed Gleason scoring as primary and secondary metrics. The patients were grouped into five categories according to the ISUP 2014 prostate cancer grading system. The relationship was strong with 64% of results staying in the same group after the operation; nevertheless, the correlation remained weak based on the kappa coefficient. Conclusion The information obtained from the needle biopsy is not a strong herald of the pathological result. Urologists should have awareness of this restraint when utilizing the needle biopsy’s Gleason score in decision making and treatment planning.

Clinically applicable Gleason grading (GD) system for prostate cancer based on deep learning.

Clinically applicable Gleason grading (GD) system for prostate cancer based on deep learning.

Evaluation of Gleason Grade Group 5 in a Contemporary Prostate Cancer Grading System and Literature Review.

The aim of this study was to validate contemporary grading systems, in particular, the Gleason grade group (GGG)5. We retrospectively reviewed the clinicopathologic data of 176 patients who underwent radical prostatectomy and whose pathologic results were GGG 4 or 5. The endpoints were biochemical recurrence (BCR) and castration-resistant prostate cancer (CRPC). The GGG 4 group was composed of 69 patients. The GGG 5 group consisted of 78 patients with GS 4+5 and 29 patients with GS 5+4 or higher. The 5-year BCR-free survival rates for men with GGG 4, GS 4+5, and GS 5+4 or higher were 59%, 54%, and 20%, respectively, and the 5-year CRPC-free survival rates were 98%, 100%, and 88%, respectively. Both the BCR- and CRPC-free survival rates were significantly higher in GS 4+5 than in GS 5+4 or higher (P< .001 and P= .002, respectively), but there were no significant differences between GGG 4 and GS 4+5 (P= .702 and P= .803, respectively). The multivariate analysis demonstrated that GS 5+4 or higher (hazard ratio, 3.4; P= .002) and lymphovascular invasion (hazard ratio, 3.4; P< .001) greatly affected BCR. Our follow-up study revealed that men with GS 4+5 and those with GGG 4 had a similar prognosis. However, there was a significant discrepancy in prognosis between GS 4+5 and GS 5+4 or higher. This suggested that GGG 4 and 5 in the contemporary prostate cancer grading system should be reviewed. Furthermore, lymphovascular invasion may be useful to subgroup these pathologically high-risk patients.

Морфологические факторы риска прогрессирования у больных раком предстательной железы после лучевой терапии

To study an importance of new 2016 WHO histologic grading system for prostate cancer in evaluating the risk of progressing after conformal external beam radiation therapy, brachytherapy 125I and androgen deprivation therapy. A total of 53 patients with prostate acinar adenocarcinoma were undergone to conformal external beam radiation therapy, brachytherapy 125I and androgen deprivation therapy. Age of patients was 54-80 years (68.11+/-4.7 years). T3 and T2 prostate cancer was diagnosed in 42 (79.3%) and 11 (20,7%) patients, respectively. Baseline PSA level ranged from 5.5 ng/ml to 311 ng/ml (39.7+/-7.9 ng/ml). According to the new grading system (the WHO classification, 2016), all patients were divided into five risk groups. Median follow-up was 64.9 months. The biochemical progression was seen in two patients, while three patients had metastatic disease. All patients with progressing prostate cancer were from IV and V prognostic groups. The 5-year progression-free survival rates for patients of IV-V and I-III groups were 44, 4% and 100%, respectively. According to the results of combination treatment (conformal external beam radiotherapy, brachytherapy 125I and hormonal therapy), progression-free survival rate in patients of IV (Gleason 4+4=8) and V (Gleason 4+5=9 or 5+5=10) groups, according to new WHO grading system were significantly lower, in comparison with patients of I (Gleason 3+3=6), II (Gleason 3+4=7) and III groups (Gleason 4+3=7). Our study showed that new WHO classification allows to predict the progression of prostate cancer not only after prostatectomy, but also after conformal external beam radiation therapy, combined with brachytherapy 125I and androgen deprivation therapy.

The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer.

Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC. We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan-Meier methods and Cox proportional hazard models. Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan-Meier curves showed significant differences in biochemical recurrence (BCR)-free survival across the groups (P < .001). In the multivariate analyses, these groups were significantly associated with BCR (4 + 3/3 + 4: hazard ratio [HR], 1.675; 3 + 4/4 + 3: HR, 1.908; and 4 + 3/4 + 3: HR, 2.699). Downgrading and upgrading from NB to RP was an independent predictor of BCR in men with GS 7 PC, which could be due to the amount of Gleason pattern 4.

Das neue ISUP 2014/WHO 2016 Prostatakarzinom-Grading – Status quo 5 Jahre nach seiner Einführung

In 2014, the International Society of Urological Pathology (ISUP) introduced a new grading system for prostate cancer (PCa), which was accepted and adopted by the World Health Organisation (WHO) in 2016. The new system defined five distinct grade groups and adjusted several histomorphological criteria. Our study aimed to systematically review and summarise the most recent literature and to compare the new grading system with the former Gleason grading. We performed a literature screening in the PubMed database. A total of 15 studies evaluating the new grading system during the period from 2016 to 2018 were selected for our review. The main goals of the new ISUP 2014/WHO 2016 grading system were a more accurate and simplified grade stratification, less overtreatment of indolent PCa as well as improved patient communication. Biochemical recurrence was the most common endpoint for statistical analysis. Most studies found that the new ISUP 2014/WHO 2016 grading system provides higher prognostic accuracy than the former Gleason grading. Notably, however, only a subset of studies clearly demonstrated that the archived samples were not only re-grouped according to the new grade groups, but also re-graded according to the new histomorphological 2014 ISUP criteria. The prognostic accuracy of the ISUP 2014/WHO 2016 grade groups was confirmed by the majority of the studies. Nevertheless, the interpretation of the study results should be based upon the criterion of correct re-grading.

MP09-20 THE DISTRIBUTION OF COMEDONECROSIS IN INTRADUCTAL VERSUS INVASIVE PROSTATE CANCER: ANALYSIS FROM A LARGE SINGLE CENTER PROSTATECTOMY SERIES

INTRODUCTION AND OBJECTIVES:Comedonecrosis has always been assigned Gleason pattern 5. Recent recommendations suggest against the grading of intraductal carcinoma. We hypothesized that prostatic adenocarcinoma with comedonecrosis may be frequently intraductal and therefore prostate cancer grading system may need to be revised.METHODS:We searched our pathology database from 2014-2018 for radical prostatectomy cases with documented comedonecrosis (specific grade patterns accounting for pattern 4 and 5 have been documented over this period). From an initial cohort of 52 cases with reported comedonecrosis, 40 cases were retrieved and had identifiable areas of comedonecrosis on additional whole mount slides prepared for immunohistochemistry. Immunohistochemical staining was performed for prostatic basal cell markers p63 and high molecular weight cytokeratin on whole-mount tumor blocks with the largest areas of comedonecrosis.RESULTS:In 24 cases (60%), the comedonecrosis was located only in intraductal carcinom...

Moving Beyond Gleason Scoring

The combination of grading and staging is the basis of current standard of care for prediction for most cancers. D. F. Gleason created the current prostate cancer (PCa) grading system. This system has been modified several times. Molecular data have been added. Currently, all grading systems are cancer-cell based. To review the literature available on host response measures as reactive stroma grading and stromogenic carcinoma, and their predictive ability for PCa biochemical recurrence and PCa-specific death. Our own experience has shown that reactive stroma grading and the subsequently binarized system (stromogenic carcinoma) can independently predict biochemical recurrence and/or PCa-specific death, particularly in patients with a Gleason score of 6 or 7. Stromogenic carcinoma has been validated by 4 other independent groups in at least 3 continents. Broders grading and Dukes staging have been combined to form the most powerful prognostic tools in standard of care. The time has come for us to incorporate measures of host response (stromogenic carcinoma) into the arsenal of elements we use to predict cancer survival, without abandoning what we know works. These data also suggest that our current definition of PCa might need some revision.

Gleason score correlation between prostate needle biopsy and radical prostatectomy materials

Prostate cancer is the second most common cancer in men. Digital rectal examination, transrectal ultrasonography and serum prostate specific antigen represents a diagnostic triad for the detection of prostatic carcinoma. About 50 years ago, Dr. Donald Gleason created a grading system for prostate cancer based on its histologic patterns. Currently, this system maintains its validity with various changes. New updates were made in 2005 and 2014 by the International Society of Urological Pathology. The goal of biopsies is to determine the Gleason score and prognosis in prostatectomy material. The aim of this study was to determine the concordance of the Gleason score, tumor volume and tumor laterality between prostate needle biopsy and prostatectomy materials. The study was performed with 112 patients who had biopsy and prostatectomy materials. The Gleason grades of the tumors have been evaluated with the new grading system. Tumor volumes were calculated by the number of positive blocks while tumor laterality was evaluated as unilateral or bilateral. Statistical analysis was performed on the obtained data. Gleason score, tumor volume and tumor laterality discordance between needle biopsy and prostatectomy materials was found to be statistically significant. However, the concordance increased as the Gleason score and tumor volume increased. Digital examination, serum prostate specific antigen value and needle biopsy together are very sensitive for a prostate adenocarcinoma diagnosis. The Gleason score, localization and volume of the tumors are important for patient follow-up, treatment and prognosis.

Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer?

PurposeThe intensity of prostate-specific membrane antigen (PSMA) expression increases as the tumor grade increases and the uptake of Ga-68-PSMA is higher in high-grade tumors. The aim of the present study was to evaluate the correlation of preoperative tracer uptake of primary tumor to Gleason Score in patients who underwent prostatectomy.Patients and methodsWe retrospectively evaluated 141 patients who had Ga-68-PSMA positron emission tomography/computed tomography (PET/CT) imaging and who underwent prostatectomy. All patients had a diagnosis of prostate cancer on the basis of 10–24 cores transrectal ultrasound-guided biopsy (TRUS-Bx). Histological assessment was performed according to the New Contemporary Prostate Cancer Grading System. All patients had a prostate-specific antigen (PSA) level measurement within maximum of 28 days before Ga-68-PSMA PET/CT. Region of interests were drawn manually around the prostate gland, avoiding the bladder activity, to calculate the maximum standardized uptake values (SUVmax) values.ResultsThe median PSA values for all patients were 10.0 ng/ml. PSA values for low-risk patients were significantly lower than those of high-risk patients (P<0.001). There were 41.1% upgrades and 7.8% downgrades following prostatectomy in terms of Grade Groups. According to the final pathology reports, 21% (n=16) of patients moved from a low-risk level (grade groups 1+2) to a high-risk level (grade groups 3+4+5). The median SUVmax value was 8.8, ranging from 2.1 to 62.4. There was a strong correlation between SUVmax values and grade groups (Pearson ρ=0.66) (P<0.001). The mean SUVmax values of high-risk patients were significantly higher than those of low-risk patients (18.9±12.1 vs. 7.16±6.2, respectively) (P<0.001). Receiver operation characteristic curve analysis of SUVmax at the cut-off value of 9.1 showed a high sensitivity (78%) and specificity (81%) for detection of high risk disease.ConclusionSUVmax values correlate significantly with the grade groups of the primary tumor. The intraprostatic accumulation sites may predict clinically significant cancer and potentially serve as a target for biopsy sampling in conjunction with mpMRI in selected patients.

The History of Urology at the Minneapolis Veterans Affairs Health Care System

ObjectiveThe Section of Urology at the Minneapolis Veteran's Affairs (VA) Medical Center has a long history of contributions to Urology including the Gleason Score, Fuhrman Grading system, testicular tumor marker development and the birth of Endourology. The objective of this manuscript is to compile and present the Urologic history of the Minneapolis VA. MethodsThe Urologic literature and institutional records originating from the Minneapolis VA Medical Center from 1946-2017 were reviewed and presented herein. ResultsThe Minneapolis VA Health Care System originated in 1921 and currently employs 5 Urologist who serve over 16,000 veterans per year. Historic achievements from the Minneapolis VA Section of Urology include the development of the Veteran's Affairs Cooperative Research Group (VACURG) which was instrumental to development of the Gleason grading system for prostate cancer in 1965. Additional urologic oncology achievements originating from the Minneapolis VA Section of Urology included the development of the diagnostic utility of tumor markers in testis cancer in 1976 and The Fuhrman Grading System in 1982. Perhaps the greatest contribution to the field of Urology was the birth of Endourology at the Minneapolis VA in the late 1970s under the direction of Dr. Paul Lange. Currently the Minneapolis VA is a premier center for Evidence Based Urology by housing Cochrane Urology and the U.S. Grading of Recommendations Assessment, Development and Evaluation network (US GRADE). ConclusionSince 1946, the section of Urology at the Minneapolis VA has contributed basic science, clinical technique and evidence based medicine to the field of Urology while providing care to the nation's veterans.

Comedonecrosis Revisited: Strong Association With Intraductal Carcinoma of the Prostate.

From the advent of the Gleason grading system for prostate cancer, cancer displaying intraluminal necrotic cells and/or karyorrhexis within cribriform/solid architecture, a phenomenon termed "comedonecrosis," has been assigned pattern 5. Intraductal carcinoma (IDC-P) shows morphologic overlap with high-grade cribriform/solid adenocarcinoma architecturally and cytologically and may also show central necrosis, yet due to the presence of basal cells at the duct periphery is not currently assigned a grade in clinical practice. On the basis of observations from routine clinical cases, we hypothesized that comedonecrosis was more significantly associated with IDC-P than invasive disease. From a large series of mapped radical prostatectomy specimens (n=933), we identified 125 high-grade (≥Gleason score 4+3=7), high-volume tumors with available slides for review. All slides were examined for the presence of unequivocal comedonecrosis. Standard immunohistochemistry for basal cell markers was performed to detect basal cell labeling in these foci. In total, 19 of 125 (15%) cases showed some ducts with comedonecrosis-9 cases with 1 focus and 10 cases with ≥2 foci; in all, a total of 73 foci of true comedonecrosis were evaluated. Immunohistochemical stains revealed labeling for basal cell markers in a basal cell distribution for at least some comedonecrosis foci in 18 of 19 (95%) cases, 12 with IDC-P exclusively and 6 with a mix of IDC-P and invasive carcinoma comedonecrosis foci. These results suggest that comedonecrosis is strongly associated with IDC-P and hence, the routine assignment of pattern 5 to carcinoma exhibiting comedonecrosis should be reconsidered.

How Are Gleason Scores Categorized in the Current Literature: An Analysis and Comparison of Articles Published in 2016–2017

BackgroundA new prostate cancer grading system was proposed in 2013 and endorsed by major journals and societies in 2014, in part because of anecdotal evidence that Gleason scores (GSs) were incorrectly combined in the literature. ObjectiveTo examine how published studies categorized GSs in current practice. Design, setting, and participantsA PubMed search was conducted on articles published in 2016–2017 using the search terms “Gleason” and “prostate”. This literature review included 1576 articles after exclusions. Results(1) Separating GS 7: pathology journals were more likely than non-pathology journals to grade GS 7 separately (56.9% vs 40.0%, p<0.05). Articles co-authored by a pathologist separated GS 7 more than those without a pathologist (53.2% vs 32.9%, p<0.001). North American and European studies separated GS 7 more than Asian studies (47.6% and 44.1% vs 24.1%, p<0.001). Clinical articles separated GS 7 more than research articles (43.7% vs 32.9%, p<0.001). (2) Separating GS 8 from GS 9–10: pathology journals separated GS 8 from GS 9–10 more than non-pathology journals (55.2% vs 34.4%, p=0.001). Articles co-authored by a pathologist separated GS 8 from GS 9–10 more often than those without a pathologist (44.9% vs 29.5%, p<0.001). (3) Using grade groups as “ideal” with all other groupings “non-ideal”: pathology journals used ideal more than non-pathology journals (32.2% vs 15.9%, p<0.001). Ideal grouping is more likely in articles co-authored by a pathologist than in those without a pathologist (20.6% vs 11.0%, p<0.001). North American and European studies used ideal grouping more than Asian studies (17.6% and 14.0% vs 9.1%, p<0.05). (4) Arranging groupings in decreasing order from ideal to non-ideal: pathology journals were closer to ideal than non-pathology journals (p=0.002). Articles co-authored by a pathologist were classified closer to ideal than those without a pathologist (p<0.001). North American (p<0.001) and European (p=0.02) studies were closer to ideal than Asian studies. ConclusionsThere is still wide variation in how GSs are grouped world-wide. Only a minority of published articles group GSs accurately. Patient summaryIn this report, we looked at how GSs were grouped world-wide. We found that only a minority of published articles on prostate cancer were grouping GSs accurately, which could lead to inaccurate results and affect patient care with different prostate cancer grades. Our study calls for more widespread adoption of the new prostate cancer grading system composed of five grade groups to minimize incorrect grouping for future studies.

FR-22 FROM "END OF UROLOGY" TO ENDOUROLOGY: UROLOGIC LEGACY OF THE THE MINNEAPOLIS VA

You have accessJournal of UrologyHistory Forum1 Apr 2018FR-22 FROM "END OF UROLOGY" TO ENDOUROLOGY: UROLOGIC LEGACY OF THE THE MINNEAPOLIS VA Giulia Lane, Maria Uloko, Vikram Narayan, and Cesar Ercole Giulia LaneGiulia Lane More articles by this author , Maria UlokoMaria Uloko More articles by this author , Vikram NarayanVikram Narayan More articles by this author , and Cesar ErcoleCesar Ercole More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3042AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Minneapolis VA Section of Urology has contributed to Urologic research and trained leaders in Urology since its affiliation with the University of Minnesota in 1946. It is the birthplace to the Gleason score, the Fuhrman grading system and Endourology. Herein we recount the Urologic contributions of the Minneapolis VAMC. METHODS A review of Urologic literature from the Minneapolis VAMC from 1946 to present. RESULTS Researchers at the Minneapolis VAMC helped shaped early innovations in Urologic Oncology. The VA Cooperative Urologic Research Group (VACURG) was developed by Dr. George Mellinger, Chief of Urology, in 1959. Dr. Mellinger enlisted Dr. Donald Gleason's aid in the development of a grading system for prostate cancer for the VACURG. Dr. Gleason's Grading system, first presented in 1965, has become the sole recommended grading system for prostate cancer. In the realm of renal tumors, Dr. Susan Fuhrman devised the Fuhrman Grading system in 1982 at the Minneapolis VAMC pathology department. The Fuhrman grading system gained popularity and has been found to be a prognostic factor for renal carcinoma. Dr. Paul Lange (VAMC Urology Chief 1977-86) alongside Dr. Thomas Hakala and Dr. Elwin Fraley (Chairman of Urology at the University of Minnesota 1969-93), studied the tumor markers for testicular cancer at the Minneapolis VAMC, providing evidence for the benefit of their clinical use.Dr. Fraley trained and recruited the Urologists that created the field of Endourology. In 1978, Dr. Arthur Smith and Dr. Lange published the first account of antegrade ureteral stent placement through a percutaneous nephrostomy tract, which was performed at the Minneapolis VAMC. Dr. Fraley coined the term Endo-Urology in 1979 and helped popularize the techniques through training courses in Minneapolis. Today, the Minneapolis VAMC is a lead institution for evidence based Urology through the work of Dr. Timothy Wilt and Dr. Philip Dahm. Dr. Wilt served as lead investigator in the the Prostate Cancer Intervention versus Observation Trial (PIVOT) and member of the United States Preventative Task Force (USPSTF) on prostate specific antigen. Dr. Dahm currenlty leads the the Cochrane Urology Collaborative Review Group from the Minneapolis VAMC. The VAMC also serves as a lead institution U.S. Grading Recommendations Assessment, Develop and Evaluation (GRADE) network. CONCLUSIONS The Minneapolis VA Section of Urology has produced leaders in Urology who contributed to the field of Urologic Oncology, founded the field of Endourology and continue to promote evidence based Urology. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1249 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Giulia Lane More articles by this author Maria Uloko More articles by this author Vikram Narayan More articles by this author Cesar Ercole More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

678 - The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy in a contemporary grading system for prostate cancer

678 - The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy in a contemporary grading system for prostate cancer

Prognostic value of the new prostate cancer grading system

Prognostic value of the new prostate cancer grading system