Prognostic Gleason grade grouping: Data based on the modified Gleason scoring system
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TLDR
In this article, the authors used the International Society of Urological Pathology (ISUP) Gleason scoring system to improve the correlation between biopsy and radical prostatectomy Gleason sum and better stratify patients to predict clinical outcomes.Abstract:
What's known on the subject? and What does the study add?
The Gleason scoring system is a well-established predictor of pathological stage and oncological outcomes for men with prostate cancer. Modifications throughout the last few decades – most recently by the International Society of Urological Pathology (ISUP) in 2005 – have attempted to improve the correlation between biopsy and radical prostatectomy Gleason sum and better stratify patients to predict clinical outcomes.
Based on these clinical outcomes and the excellent prognosis for patients with low Gleason scores, we recommend Gleason grades incorporating a prognostic grade grouping which accurately reflect prognosis and are clearly understood by physicians and patients alike.
Objective
To investigate pathological and short-term outcomes since the most recent Gleason system modifications by the International Society of Urological Pathology (ISUP) in an attempt to divide the current Gleason grading system into prognostically accurate Gleason grade groups.
Patients and Methods
We queried the Johns Hopkins Radical Prostatectomy Database (1982–2011), approved by the institutional review board, for men undergoing radical prostatectomy (RP) without a tertiary pattern since 2004 and identified 7869 men.
Multivariable models were created using preoperative and postoperative variables; prognostic grade group (Gleason grade ≤6; 3 + 4; 4 + 3; 8; 9–10) was among the strongest predictors of biochemical recurrence-free (BFS) survival.
Results
Significant differences were noted among the Gleason grade groups at biopsy; differences were noted in the race, PSA level, clinical stage, number of positive cores at biopsy and the maximum percentage of positive cores among the Gleason grade groups at RP.
With a median (range) follow-up of 2 (1–7) years, 5-year BFS rates for men with Gleason grade ≤6, 3 + 4, 4 + 3, 8 and 9–10 tumours at biopsy were 94.6, 82.7, 65.1, 63.1 and 34.5%, respectively (P < 0.001 for trend); and 96.6, 88.1, 69.7, 63.7 and 34.5%, respectively (P < 0.001), based on RP pathology.
Conclusions
The 2005 ISUP modifications to the Gleason grading system for prostate carcinoma accurately categorize patients by pathological findings and short-term biochemical outcomes but, while retaining the essence of the Gleason system, there is a need for a change in its reporting to more closely reflect tumour behaviour.
We propose reporting Gleason grades, including prognostic grade groups which accurately reflect prognosis as follows: Gleason score ≤6 (prognostic grade group I); Gleason score 3+4=7 (prognostic grade group II); Gleason score 4+3=7 (prognostic grade group III); Gleason score 4+4=8 (prognostic grade group (IV); and Gleason score 9–10 (prognostic grade group (V).read more
Citations
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Journal ArticleDOI
The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System.
Jonathan I. Epstein,Lars Egevad,Mahul B. Amin,Brett Delahunt,John R. Srigley,Peter A. Humphrey +5 more
TL;DR: The basis for a new grading system was proposed in 2013 by one of the authors and accepted by the World Health Organization for the 2016 edition of Pathology and Genetics: Tumours of the Urinary System and Male Genital Organs.
Journal ArticleDOI
The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours.
TL;DR: Modifications to the Gleason grading system are incorporated into the 2016 WHO section on grading of prostate cancer, and it is recommended that the percentage of pattern 4 should be reported for Gleason score 7.
Journal ArticleDOI
A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score.
Jonathan I. Epstein,Michael J. Zelefsky,Daniel Sjöberg,Joel B. Nelson,Lars Egevad,Cristina Magi-Galluzzi,Andrew J. Vickers,Anil V. Parwani,Victor E. Reuter,Samson W. Fine,James A. Eastham,Peter Wiklund,Misop Han,Chandana A. Reddy,Jay P. Ciezki,Tommy Nyberg,Eric A. Klein +16 more
TL;DR: Looking at outcomes for prostate cancer treated with radical prostatectomy or radiation therapy and validated a new grading system with more accurate grade stratification than current systems, including a simplified grading system of five grades and the lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa.
Journal ArticleDOI
Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer.
Jeffrey J. Tosoian,Mufaddal Mamawala,Jonathan I. Epstein,Patricia Landis,Sacha Wolf,Bruce J. Trock,H. Ballentine Carter +6 more
TL;DR: Men with favorable-risk prostate cancer should be informed of the low likelihood of harm from their diagnosis and should be encouraged to consider surveillance rather than curative intervention.
Journal ArticleDOI
MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis
Michael Ahdoot,Andrew R Wilbur,Sarah E Reese,Amir H. Lebastchi,Sherif Mehralivand,Patrick T. Gomella,Jonathan Bloom,Sandeep Gurram,Minhaj Siddiqui,Paul F. Pinsky,Howard L. Parnes,W. Marston Linehan,Maria Merino,Peter L. Choyke,Joanna H. Shih,Baris Turkbey,Bradford J. Wood,Peter A. Pinto +17 more
TL;DR: Among patients with MRI-visible lesions, combined biopsy led to more detection of all prostate cancers, however, MRI-targeted biopsy alone underestimated the histologic grade of some tumors.
References
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Journal ArticleDOI
The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma
Geert J.L.H. van Leenders,Theodorus van der Kwast,David J. Grignon,Andrew Evans,Glen Kristiansen,Charlotte F. Kweldam,Geert Litjens,Jesse K. McKenney,Jonathan Melamed,N. Mottet,Gladell P. Paner,Hemamali Samaratunga,Ivo G. Schoots,Jeffry P. Simko,Toyonori Tsuzuki,Murali Varma,Anne Y. Warren,Thomas M. Wheeler,Sean R. Williamson,Kenneth A. Iczkowski +19 more
TL;DR: This manuscript summarizes the proceedings of the ISUP consensus meeting for grading of prostatic carcinoma held in September 2019, in Nice, France, where topics brought to consensus included approaches to reporting of Gleason patterns 4 and 5 quantities, and minor/tertiary patterns.
Journal ArticleDOI
Prediction of Prognosis for Prostatic Adenocarcinoma by Combined Histological Grading and Clinical Staging
TL;DR: The data for stages III and IV patients with histologically low grade cancers suggest that these patients are at no greater risk of death from cancer than most stages I and II patients for whom radical prostatectomy has been recommended.
Journal ArticleDOI
Correlation of pathologic findings with progression after radical retropubic prostatectomy.
TL;DR: This study was performed to evaluate the effect of positive margins, Gleason grade, and capsular penetration on progression after radical prostatectomy.
Journal ArticleDOI
Prognostic significance of Gleason score 3+4 versus Gleason score 4+3 tumor at radical prostatectomy.
TL;DR: Although the assessment of the percentage of pattern 4 at radical prostatectomy is not likely to be reproducible, the distinction between Gleason score 3+4 and 4+3 should be easier for pathologists to perform.
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A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score.
The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma
Geert J.L.H. van Leenders,Theodorus van der Kwast,David J. Grignon,Andrew Evans,Glen Kristiansen,Charlotte F. Kweldam,Geert Litjens,Jesse K. McKenney,Jonathan Melamed,N. Mottet,Gladell P. Paner,Hemamali Samaratunga,Ivo G. Schoots,Jeffry P. Simko,Toyonori Tsuzuki,Murali Varma,Anne Y. Warren,Thomas M. Wheeler,Sean R. Williamson,Kenneth A. Iczkowski +19 more