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Modified Gleason grading. An updated review.

Burkhard Helpap1, Lars Egevad

  • 1Department of Pathology, Center of Uropathology, General Hospital Hegau-Bodensee-Klinikum Singen, Academic Hospital of the University of Freiburg, Germany. burkhard.helpap@hbh-kliniken.de

Histology and Histopathology
|March 14, 2009
PubMed
Summary
This summary is machine-generated.

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The revised Gleason grading system for prostate cancer showed a shift towards higher scores (7a) in biopsies. This updated system better correlates grade, stage, and PSA levels, distinguishing low from high-grade prostate cancer.

Area of Science:

  • Uropathology
  • Oncology

Background:

  • The International Society of Urological Pathology (ISUP) revised the Gleason grading system in 2005.
  • The previous Gleason system (1966) was updated to improve prostate cancer grading.

Purpose of the Study:

  • To evaluate the impact of the modified Gleason grading system on prostate carcinoma classification.
  • To assess the correlation between Gleason scores, tumor stage, and PSA levels.

Main Methods:

  • Analysis of biopsy and radical prostatectomy specimens using the modified Gleason grading system.
  • Correlation of Gleason scores with pathological stage (pT2 vs. pT3-4) and PSA levels.

Main Results:

  • A shift in the most frequent Gleason scores from 6 to 7a (3+4) in biopsy specimens was observed.

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  • Increased agreement between biopsy and radical prostatectomy Gleason scores.
  • Gleason score 7a (3+4) tumors were predominantly pT2, while 7b (4+3) tumors were pT3-4.
  • Lower Gleason scores (6 and 7a) were associated with PSA <10 ng/ml and tumor extent <20%.

    • Conclusions:

    • The modified Gleason system effectively correlates grade, stage, tumor extent, and PSA.
    • This system aids in differentiating between low and high-grade prostate carcinoma, including potentially insignificant cases.