Skip to main content
SpringerLink
Log in

Contemporary Gleason Grading System

  • Chapter
  • First Online:
Genitourinary Pathology

Abstract

Despite the modifications in the past four decades, Gleason grading system has been validated as a fundamental prognostic factor for prostate cancer, both on biopsy and on radical prostatectomy. The modification in 2005 International Society of Urologic Pathology (ISUP) Gleason grading system had an enormous impact on the contemporary practice of prostate cancer. Although 2005 ISUP modified grading system is still imperfect, there is no other marker or grading system that can be as quickly and reproducibly applied in practice, which highlights the role of the pathology in patient management. For a pathologist, the key issue remains the use of consistent grading criteria, which reflect the mainstream grading trends. Further modifications and refinements of the criteria need to be carefully validated and confirmed in large or multi-institutional studies with well-defined outcomes, before additional changes are implemented, preferably based through a broad international consensus. Thus, ISUP modified Gleason system still remains one of the most powerful grading schemes in all of urologic oncology and a gold standard against which other prospective markers are and will be compared with and measured against in future studies. This chapter summarizes the recent developments and modifications of the Gleason grading system and their impact in contemporary clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gleason DF. Classification of prostatic carcinomas. Cancer Chemother Rep. 1966;50(3):125–8.

    CAS  PubMed  Google Scholar 

  2. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 1974;111(1):58–64.

    CAS  PubMed  Google Scholar 

  3. Gleason DF. Histologic grading and clinical staging of prostatic carcinoma. In: Teannenbaum M, editor. Urologic pathology: the prostate. the veterans administration cooperative urological research group. Philadelphia: Lea and Febiger; 1977. pp. 171–97.

    Google Scholar 

  4. Epstein JI, Allsbrook WC Jr., Amin MB, Egevad LL. The 2005 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol. 2005;29(9):1228–42.

    Article  PubMed  Google Scholar 

  5. Gleason DF. Histologic grading of prostate cancer: a perspective. Hum Pathol. 1992;23(3):273–9.

    Article  CAS  PubMed  Google Scholar 

  6. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2012;62(1):10–29.

    Article  PubMed  Google Scholar 

  7. Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?. J Urol. 2004;172(4 Pt 1):1297–301.

    Article  PubMed  Google Scholar 

  8. Egevad L, Mazzucchelli R, Montironi R. Implications of the international society of urological pathology modified Gleason grading system. Arch Pathol Lab Med. 2012;136(4):426–34.

    Article  PubMed  Google Scholar 

  9. Egevad L, Allsbrook WC, Jr., Epstein JI. Current practice of diagnosis and reporting of prostate cancer on needle biopsy among genitourinary pathologists. Hum Pathol. 2006;37(3):292–7.

    Article  PubMed  Google Scholar 

  10. Srigley JR, Amin MB, Epstein JI, Grignon DJ, Humphrey PA, Renshaw AA, et al. Updated protocol for the examination of specimens from patients with carcinomas of the prostate gland. Arch Pathol Lab Med. 2006;130(7):936–46.

    PubMed  Google Scholar 

  11. Berney DM. The case for modifying the Gleason grading system. BJU Int. 2007;100(4):725–6.

    Article  PubMed  Google Scholar 

  12. 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(4):477–8.

    Article  CAS  PubMed  Google Scholar 

  13. Epstein JI. An update of the Gleason grading system. J Urol. 2010;183(2):433–40.

    Article  PubMed  Google Scholar 

  14. Lotan TL, Epstein JI. Clinical implications of changing definitions within the Gleason grading system. Nat Rev Urol. 2010;7(3):136–42.

    Article  PubMed  Google Scholar 

  15. Latour M, Amin MB, Billis A, Egevad L, Grignon DJ, Humphrey PA, 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(10):1532–9.

    Article  PubMed  Google Scholar 

  16. Yaskiv O, Cao D, Humphrey PA. Microcystic adenocarcinoma of the prostate: a variant of pseudohyperplastic and atrophic patterns. Am J Surg Pathol. 2010;34(4):556–61.

    Article  PubMed  Google Scholar 

  17. Pan CC, Potter SR, Partin AW, Epstein JI. 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(4):563–9.

    Article  CAS  PubMed  Google Scholar 

  18. Trock BJ, Guo CC, Gonzalgo ML, Magheli A, Loeb S, Epstein JI. Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system. J Urol. 2009;182(4):1364–70.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Mosse CA, Magi-Galluzzi C, Tsuzuki T, Epstein JI. The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol. 2004;28(3):394–8.

    Article  PubMed  Google Scholar 

  20. Isbarn H, Ahyai SA, Chun FK, Budaus L, Schlomm T, Salomon G, et al. Prevalence of a tertiary Gleason grade and its impact on adverse histopathologic parameters in a contemporary radical prostatectomy series. Eur Urol. 2009;55(2):394–401.

    Article  PubMed  Google Scholar 

  21. Ikenberg K, Zimmermann AK, Kristiansen G. Re: tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system. Trock BJ, Guo CC, Gonzalgo ML, Magheli A, Loeb S, Epstein JI. J Urol 2009;182:1364–1370. J Urol. 2010;183(5):2100. Author reply-1.

    Google Scholar 

  22. Patel AA, Chen MH, Renshaw AA, D’Amico AV. PSA failure following definitive treatment of prostate cancer having biopsy Gleason score 7 with tertiary grade 5. JAMA. 2007;298(13):1533–8.

    Article  CAS  PubMed  Google Scholar 

  23. Nanda A, Chen MH, Renshaw AA, D’Amico AV. Gleason Pattern 5 prostate cancer: further stratification of patients with high-risk disease and implications for future randomized trials. Int J Radiat Oncol Biol Phys. 2009;74(5):1419–23.

    Article  PubMed  Google Scholar 

  24. Trpkov K, Zhang J, Chan M, Eigl BJ, Yilmaz A. Prostate cancer with tertiary Gleason pattern 5 in prostate needle biopsy: clinicopathologic findings and disease progression. Am J Surg Pathol. 2009;33(2):233–40.

    Article  PubMed  Google Scholar 

  25. Rubin MA, Dunn R, Kambham N, Misick CP, O’Toole KM. Should a Gleason score be assigned to a minute focus of carcinoma on prostate biopsy? Am J Surg Pathol. 2000;24(12):1634–40.

    Article  CAS  PubMed  Google Scholar 

  26. Donnelly BJ, Saliken JC, Brasher PM, Ernst SD, Rewcastle JC, Lau H, et al. A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer. Cancer. 2010;116(2):323–30.

    Article  CAS  PubMed  Google Scholar 

  27. Zelefsky MJ, Reuter VE, Fuks Z, Scardino P, Shippy A. Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer. J Urol. 2008;179(4):1368–73; discussion 73.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Helpap B, Egevad L. The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens. Virchows Arch. 2006;449(6):622–7.

    Article  PubMed  Google Scholar 

  29. Zareba P, Zhang J, Yilmaz A, Trpkov K. The impact of the 2005 international society of urological pathology (ISUP) consensus on Gleason grading in contemporary practice. Histopathology. 2009;55(4):384–91.

    Article  PubMed  Google Scholar 

  30. Uemura H, Hoshino K, Sasaki T, Miyoshi Y, Ishiguro H, Inayama Y, 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(9):1190–4.

    Article  PubMed  Google Scholar 

  31. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol. 2012;61(5):1019–24.

    Article  PubMed  Google Scholar 

  32. Rubin MA, Bismar TA, Curtis S, Montie JE. Prostate needle biopsy reporting: how are the surgical members of the Ssociety of urologic oncology using pathology reports to guide treatment of prostate cancer patients? Am J Surg Pathol. 2004;28(7):946–52.

    Article  PubMed  Google Scholar 

  33. Griffiths DF, Melia J, McWilliam LJ, Ball RY, Grigor K, Harnden P, et al. A study of Gleason score interpretation in different groups of UK pathologists; techniques for improving reproducibility. Histopathology. 2006;48(6):655–62.

    Article  CAS  PubMed  Google Scholar 

  34. Melia J, Moseley R, Ball RY, Griffiths DF, Grigor K, Harnden P, et al. A UK-based investigation of inter-and intra-observer reproducibility of Gleason grading of prostatic biopsies. Histopathology. 2006;48(6):644–54.

    Article  CAS  PubMed  Google Scholar 

  35. Lopez-Beltran A, Mikuz G, Luque RJ, Mazzucchelli R, Montironi R. Current practice of Gleason grading of prostate carcinoma. Virchows Arch. 2006;448(2):111–8.

    Article  PubMed  Google Scholar 

  36. Berney DM, Fisher G, Kattan MW, Oliver RT, Moller H, Fearn P, et al. Major shifts in the treatment and prognosis of prostate cancer due to changes in pathological diagnosis and grading. BJU Int. 2007;100(6):1240–4.

    Article  PubMed  Google Scholar 

  37. Dong F, Wang C, Farris B, Wu S, Lee H, Olumi AF, et al. Impact on the clinical outcome of prostate cancer by the 2005 international society of urological pathology modified Gleason grading system. Am J Surg Pathol. 2012:36(6):838–43.

    Article  PubMed  Google Scholar 

  38. Pierorazio PM, Walsh P, Partin A, Epstein J. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int. 2013;111(5):753–60.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Billis A, Guimaraes MS, Freitas LL, Meirelles L, Magna LA, Ferreira U. 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(2):548–52; discussion 52–3.

    Article  PubMed  Google Scholar 

  40. Fajardo DA, Miyamoto H, Miller JS, Lee TK, Epstein JI. Identification of Gleason pattern 5 on prostatic needle core biopsy: frequency of underdiagnosis and relation to morphology. Am J Surg Pathol. 2011;35(11):1706–11.

    Article  PubMed  Google Scholar 

  41. Albertsen PC, Hanley JA, Barrows GH, Penson DF, Kowalczyk PD, Sanders MM, et al. Prostate cancer and the Will Rogers phenomenon. J Natl Cancer Inst. 2005;97(17):1248–53.

    Article  PubMed  Google Scholar 

  42. Tsivian M, Sun L, Mouraviev V, Madden JF, Mayes JM, Moul JW, et al. Changes in Gleason score grading and their effect in predicting outcome after radical prostatectomy. Urology. 2009;74(5):1090–3.

    Article  PubMed  Google Scholar 

  43. Delahunt B, Lamb DS, Srigley JR, Murray JD, Wilcox C, Samaratunga H, et al. Gleason scoring: a comparison of classical and modified (international society of urological pathology) criteria using nadir PSA as a clinical end point. Pathology. 2010;42(4):339–43.

    Article  PubMed  Google Scholar 

  44. Iczkowski KA, Torkko KC, Kotnis GR, Wilson RS, Huang W, Wheeler TM, et al. Digital quantification of five high-grade prostate cancer patterns, including the cribriform pattern, and their association with adverse outcome. Am J Clin Pathol. 2011;136(1):98–107.

    Article  PubMed  Google Scholar 

  45. Osunkoya AO, Nielsen ME, Epstein JI. Prognosis of mucinous adenocarcinoma of the prostate treated by radical prostatectomy: a study of 47 cases. Am J Surg Pathol. 2008;32(3):468–72.

    Article  PubMed  Google Scholar 

  46. Lotan TL, Epstein JI. Gleason grading of prostatic adenocarcinoma with glomeruloid features on needle biopsy. Hum Pathol. 2009;40(4):471–7.

    Article  PubMed Central  PubMed  Google Scholar 

  47. 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;40(12):1693–8.

    Article  CAS  PubMed  Google Scholar 

  48. Ross HM, Kryvenko ON, Cowan JE, Simko JP, Wheeler TM, Epstein JI. Do adenocarcinomas of the prostate with Gleason score (GS) < / = 6 have the potential to metastasize to lymph nodes? Am J Surg Pathol. 2012;36(9):1346–52.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Reese AC, Cowan JE, Brajtbord JS, Harris CR, Carroll PR, Cooperberg MR. The quantitative Gleason score improves prostate cancer risk assessment. Cancer. 2012;118(24):6046–54.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, General Hospital, 7007 14th Street, T2V1P9, Calgary, AB, Canada

    Prof. Kiril Trpkov

Authors
  1. Prof. Kiril Trpkov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kiril Trpkov .

Editor information

Editors and Affiliations

  1. Department of Pathology, The Cleveland Clinic, Cleveland, Ohio, USA

    Cristina Magi-Galluzzi

  2. Department of Pathology, The Cleveland Clinic, Cleveland, Ohio, USA

    Christopher G. Przybycin

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Trpkov, K. (2015). Contemporary Gleason Grading System. In: Magi-Galluzzi, C., Przybycin, C. (eds) Genitourinary Pathology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2044-0_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2044-0_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2043-3

  • Online ISBN: 978-1-4939-2044-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation