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Contemporary Approach to Gleason Grading of Prostate Cancer

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Prostate Biopsy Interpretation

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Abstract

Since its inception in 1966 by Dr. Donald Gleason, the Gleason grading system has remained a cornerstone in the diagnosis and management of prostate cancer. With widespread utilization of prostate-specific antigen (PSA) screening, the diagnosis and management of prostate cancer have dramatically changed. Clinical outcomes have also drastically changed over the past several decades. Furthermore, there is a better understanding of the morphological spectrum of prostate cancer. All these changes have prompted two modifications and refinement of the original Gleason grading criteria and reporting for contemporary practice. The most significant changes were introduced in 2005 International Society of Urologic Pathology Consensus Conference, and further modifications were recently introduced in 2014. The resulting grading system has been termed as “modified Gleason grading system.”

This chapter addresses several important definitional and operational changes to the original Gleason grading system in contemporary practice: rare utilization of Gleason patterns 1 and 2; the refinement of histological criteria for Gleason patterns 3 and 4; grading of unusual variant morphologies of prostate cancer; the significance of tertiary pattern 5; and recommendations for reporting in the setting of extended biopsy, reporting percentage pattern 4, and reporting in the setting of multifocal prostate cancers. Finally, the new grading system, which utilizes a novel method of grouping Gleason grades and its impact on outcomes, is also addressed.

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Authors and Affiliations

  1. Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA

    Rajal B. Shah

  2. Tufts Medical Center, Boston, MA, USA

    Ming Zhou

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  1. Rajal B. Shah
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  2. Ming Zhou
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Correspondence to Rajal B. Shah .

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Shah, R.B., Zhou, M. (2019). Contemporary Approach to Gleason Grading of Prostate Cancer. In: Prostate Biopsy Interpretation. Springer, Cham. https://doi.org/10.1007/978-3-030-13601-7_5

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  • DOI: https://doi.org/10.1007/978-3-030-13601-7_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-13600-0

  • Online ISBN: 978-3-030-13601-7

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