The Journal of Urology
Volume 183, Issue 2 , Pages 433-440 , February 2010

An Update of the Gleason Grading System

  • Jonathan I. Epstein

      Affiliations

    • Corresponding Author InformationCorrespondence: Department of Pathology, Johns Hopkins Hospital, Weinberg Building, 401 North Broadway, Rm. 2242, Baltimore, Maryland 21231 (telephone: 410-955-3580; FAX: 410-955-0115)

Received 4 June 2009

References 

  1. Mellinger GT, Gleason D, Bailar J. The histology and prognosis of prostatic cancer. J Urol. 1967;97:331
  2. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 1974;111:58
  3. Mellinger GT. Prognosis of prostatic carcinoma. Recent Results Cancer Res. 1977;60:61
  4. Amin MB, Schultz DS, Zarbo RJ. Analysis of cribriform morphology in prostatic neoplasia using antibody to high-molecular-weight cytokeratins. Arch Pathol Lab Med. 1994;118:260
  5. Epstein JI, Allsbrook WC, Amin MB, et al. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005;29:1228
  6. Epstein JI. Gleason score 2–4 adenocarcinoma of the prostate on needle biopsy: a diagnosis that should not be made. Am J Surg Pathol. 2000;24:477
  7. Ghani KR, Grigor K, Tulloch DN, et al. Trends in reporting Gleason score 1991 to 2001: changes in the pathologist's practice. Eur Urol. 2005;47:196
  8. Helpap B, Egevad L. The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens. Virchows Arch. 2006;449:622
  9. Epstein JI, Paull G, Eggleston JC, et al. Prognosis of untreated stage A1 prostatic carcinoma: a study of 94 cases with extended followup. J Urol. 1986;136:837
  10. Berney DM. The case for modifying the Gleason grading system. BJU Int. 2007;100:725
  11. Latour M, Amin MB, Billis A, et al. Grading of invasive cribriform carcinoma on prostate needle biopsy: an interobserver study among experts in genitourinary pathology. Am J Surg Pathol. 2008;32:1532
  12. Billis A, Guimaraes MS, Freitas LL, et al. The impact of the 2005 International Society of Urological Pathology consensus conference on standard Gleason grading of prostatic carcinoma in needle biopsies. J Urol. 2008;180:548
  13. Gofrit ON, Zorn KC, Steinberg GD, et al. The Will Rogers phenomenon in urological oncology. J Urol. 2008;179:28
  14. Miyamoto H, Hernandez DJ, Epstein JI. A pathological reassessment of organ-confined, Gleason score 6 prostatic adenocarcinomas that progress after radical prostatectomy. Hum Pathol. 2009;Epub ahead of print
  15. Hernandez DJ, Nielsen ME, Han M, et al. Natural history of pathologically organ-confined (pT2), Gleason score 6 or less, prostate cancer after radical prostatectomy. Urology. 2008;72:172
  16. Zhao J, Epstein JI. High-grade foamy gland prostatic adenocarcinoma on biopsy or transurethral resection: a morphologic study of 55 cases. Am J Surg Pathol. 2009;33:583
  17. Nelson RS, Epstein JI. Prostatic carcinoma with abundant xanthomatous cytoplasm (Foamy gland carcinoma). Am J Surg Pathol. 1996;20:419
  18. Levi AW, Epstein JI. Pseudohyperplastic prostatic adenocarcinoma on needle biopsy and simple prostatectomy. Am J Surg Pathol. 2000;24:1039
  19. Brinker DA, Potter SR, Epstein JI. Ductal adenocarcinoma of the prostate diagnosed on needle biopsy: correlation with clinical and radical prostatectomy findings and progression. Am J Surg Pathol. 1999;23:1471
  20. Tavora F, Epstein JI. High-grade prostatic intraepithelial neoplasia-like ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases. Am J Surg Pathol. 2008;32:1060
  21. Mackey JR, Au HJ, Hugh J, et al. Genitourinary small cell carcinoma: determination of clinical and therapeutic factors associated with survival. J Urol. 1998;159:1624
  22. Tetu B, Ro JY, Ayala AG, et al. Small cell carcinoma of prostate associated with myasthenic (Eaton-Lambert) syndrome. Urology. 1989;33:148
  23. Patel AA, Chen MH, Renshaw AA, et al. PSA failure following definitive treatment of prostate cancer having biopsy Gleason score 7 with tertiary grade 5. JAMA. 2007;298:1533
  24. Trpkov K, Zhang J, Chan M, et al. Prostate cancer with tertiary Gleason pattern 5 in prostate needle biopsy: clinicopathologic findings and disease progression. Am J Surg Pathol. 2009;33:233
  25. Yoon GS, Wang W, Osunkoya AO, et al. Residual tumor potentially left behind after local ablation therapy in prostate adenocarcinoma. J Urol. 2008;179:2203
  26. Deshmukh N, Foster CS. Grading prostate cancer. In:  Foster CS,  Bostwick DG editor. Pathology of the Prostate. Philadelphia: WB Saunders; 1998;p. 191–227
  27. van Oort IM, Schout BM, Kiemeney LA, et al. Does the tertiary Gleason pattern influence the PSA progression-free interval after retropubic radical prostatectomy for organ-confined prostate cancer?. Eur Urol. 2005;48:572
  28. Pan CC, Potter SR, Partin AW, et al. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol. 2000;24:563
  29. Mosse CA, Magi-Galluzzi C, Tsuzuki T, et al. The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol. 2004;28:394
  30. Sim HG, Telesca D, Culp SH, et al. Tertiary Gleason pattern 5 in Gleason 7 prostate cancer predicts pathological stage and biochemical recurrence. J Urol. 2008;179:1775
  31. Whittemore DE, Hick EJ, Carter MR, et al. Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens. J Urol. 2008;179:516
  32. Trock BJ, Guo CC, Gonzalgo ML, et al. Tertiary Gleason patterns and biochemical recurrence after radical prostatectomy: proposal for a modified Gleason scoring system. J Urol. 2009;182:1364
  33. Stamey TA, McNeal JE, Yemoto CM, et al. Biological determinants of cancer progression in men with prostate cancer. JAMA. 1999;281:1395
  34. Harnden P, Shelley MD, Coles B, et al. Should the Gleason grading system for prostate cancer be modified to account for high-grade tertiary components? (A systematic review and meta-analysis). Lancet Oncol. 2007;8:411
  35. Hattab EM, Koch MO, Eble JN, et al. Tertiary Gleason pattern 5 is a powerful predictor of biochemical relapse in patients with Gleason score 7 prostatic adenocarcinoma. J Urol. 2006;175:1695
  36. Rasiah KK, Stricker PD, Haynes AM, et al. Prognostic significance of Gleason pattern in patients with Gleason score 7 prostate carcinoma. Cancer. 2003;98:2560
  37. Rubin MA, Bismar TA, Curtis S, et al. Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients?. Am J Surg Pathol. 2004;28:946
  38. Descazeaud A, Rubin MA, Allory Y, et al. What information are urologists extracting from prostate needle biopsy reports and what do they need for clinical management of prostate cancer?. Eur Urol. 2005;48:911
  39. Kunz GM, Epstein JI. Should each core with prostate cancer be assigned a separate gleason score?. Hum Pathol. 2003;34:911
  40. Poulos CK, Daggy JK, Cheng L. Preoperative prediction of Gleason grade in radical prostatectomy specimens: the influence of different Gleason grades from multiple positive biopsy sites. Mod Pathol. 2005;18:228
  41. Park HK, Choe G, Byun SS, et al. Evaluation of concordance of Gleason score between prostatectomy and biopsies that show more than two different Gleason scores in positive cores. Urology. 2006;67:110
  42. Kuroiwa K, Uchino H, Yokomizo A, et al. Impact of reporting rules of biopsy Gleason score for prostate cancer. J Clin Pathol. 2009;62:260
  43. Uemura H, Hoshino K, Sasaki T, et al. Usefulness of the 2005 International Society of Urologic Pathology Gleason grading system in prostate biopsy and radical prostatectomy specimens. BJU Int. 2009;103:1190

 Nothing to disclose.

 Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 834 and 835.

PII: S0022-5347(09)02704-9

doi: 10.1016/j.juro.2009.10.046

The Journal of Urology
Volume 183, Issue 2 , Pages 433-440 , February 2010

Article Tools

* Image Usage & Resolution