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An update of the Gleason grading system.
1Department of Pathology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, The Johns Hospital, Baltimore, Maryland 21231, USA. jepstein@jhmi.edu
The Journal of Urology
|December 17, 2009
Summary
The Gleason grading system for prostate cancer has been updated to improve accuracy and clinical utility. These modifications enhance prognostic prediction and guide treatment decisions in urological pathology.
Area of Science:
- Urological Pathology
- Oncology
- Prostate Cancer Research
Background:
- The Gleason grading system has been a cornerstone in prostate cancer prognostication for over 40 years.
- Significant advancements in prostate cancer diagnostics, including PSA testing and improved biopsy techniques, necessitate system updates.
Purpose of the Study:
- To provide an update on the evolution and modifications of the Gleason grading system.
- To highlight recent changes in grading prostate cancer variants and subtypes.
Main Methods:
- A comprehensive literature search of MEDLINE(R) and relevant study references was conducted.
- Analysis of changes implemented following the 2005 International Society of Urological Pathology consensus conference.
Main Results:
- Key modifications include reclassification of certain patterns, grading of cribriform cancer as pattern 4, and revised grading for prostate cancer variants.
- The system now addresses reporting of secondary and tertiary Gleason patterns, with a proposed modified system for radical prostatectomy specimens.
- Studies confirm the superiority of the modified Gleason system, impacting urological practice and patient management.
Conclusions:
- The Gleason grading system remains a powerful prognostic factor for prostate cancer.
- Adaptations ensure the system's continued relevance in evolving medical practice.
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