Critical issues in grading of adenocarcinomas of the prostate

This article reviews the Gleason grading system and compares it to some of the other commonly used grading systems. Issues concerning both intra-and interobserver reproducibility of the Gleason grading system are presented. This article provides an in-depth analysis of the correlation between biopsy and radical prostatectomy Gleason score. New data from a study performed at Johns Hopkins Hospital provides reasons for discrepant grading between biopsy and a resection specimen. Finally, the prognostic capabilities of the Gleason grading system as it relates to radical prostatectomy, needle biopsy, and transurethral resection are discussed.