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Review
. 2016 Mar 9:11:25.
doi: 10.1186/s13000-016-0478-2.

Grading of prostatic adenocarcinoma: current state and prognostic implications

Jennifer Gordetsky  1   2 , Jonathan Epstein  3   4
Affiliations
Review

Grading of prostatic adenocarcinoma: current state and prognostic implications

Jennifer Gordetsky et al. Diagn Pathol. .

Abstract

Background: Despite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient's prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care.

Main body: We describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10.

Conclusion: As this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.

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Figures

Fig. 1
Fig. 1
The original Gleason Grading system diagram
Fig. 2
Fig. 2
a Gleason score 3 + 3 = 6 (Grade Group 1). b Gleason score 3 + 4 = 7 (Grade Group 2) with minor component of cribriform glands. c Gleason score 4 + 4 = 8 (Grade Group 4) with irregular cribriform glands. d Gleason score 4 + 4 = 8 (Grade Group 4) with fused glands with cytoplasmic vacuoles. e Gleason score 4 + 4 = 8 (Grade Group 4) with glomeruloid glands. f Gleason score 4 + 4 = 8 (Grade Group 4) with poorly-formed glands
Fig. 3
Fig. 3
a Gleason score 5 + 5 = 10 (Grade Group 5) with solid sheets of cells. b Gleason score 5 + 5 = 10 (Grade Group 5) with cords of cells. c Gleason score 5 + 5 = 10 (Grade Group 5) with individual cells. d Gleason score 5 + 4 = 9 (Grade Group 5) with cribriform glands, some with necrosis. e Intraductal carcinoma with necrosis (left), surrounded by basal cells highlighted by p63 and high molecular weight cytokeratin (right) and positive for racemase. f Mucinous adenocarcinoma Gleason score 3 + 4 = 7 (Grade Group 2) with individual well-formed glands and minor component of cribriform glands floating in extracellular mucin
See this image and copyright information in PMC

References

    1. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 1974;111:58–64. - PubMed
    1. Epstein JI, Allsbrook WC, Jr, Amin MB, Egevad LL. ISUP Grading Committee. The 2005 International Society of Urological Pathology(ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005;29:1228–42. doi: 10.1097/01.pas.0000173646.99337.b1. - DOI - PubMed
    1. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. 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. Am J Surg Pathol. 2016;40(2):244–52. - PubMed
    1. Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: data based on the modified Gleason scoring sys- tem. BJU Int. 2013;111:753–60. doi: 10.1111/j.1464-410X.2012.11611.x. - DOI - PMC - PubMed
    1. Epstein JI, Zelefsky MJ, Sjoberg DD, Nelson JB, Egevad L, Magi-Galluzzi C, Vickers AJ, Parwani AV, Reuter VE, Fine SW, Eastham JA, Wiklund P, Han M, Reddy CA, Ciezki JP, Nyberg T, Klein EA. A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score. Eur Urol. 2016;69(3):428-35. - PMC - PubMed

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