Contemporary Approach to Gleason Grading of Prostate Cancer

  • Rajal B. ShahEmail author
  • Ming Zhou


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.


Gleason grading system Gleason pattern Gleason score Prostate-specific antigen International Society of Urologic Pathologists (ISUP) consensus recommendations Modified Gleason grading system Partin table Han table Nomograms NCCN recurrence risk categories Cribriform carcinoma Grade group Percentage pattern 4 tertiary pattern Glomeruloid pattern Active surveillance Mucinous fibroplasia Collagenous micronodule Poorly formed gland Gleason pattern 4 Transurethral resection of the prostate (TURP) Cribriform architecture Intraductal carcinoma IDC-P 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Robert J Tomsich Pathology and Laboratory Medicine InstituteCleveland ClinicClevelandUSA
  2. 2.Tufts Medical CenterBostonUSA

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