The Value of Prognostic Grouping of Prostatic Carcinomas for Urologists and Pathologists

To improve the prognostic stratification for different therapeutic options of prostatic carcinomas (PCa) with low and intermediate grade by combining Gleason grading with cytological findings and prognostic grade grouping.

We analyzed PCa after radical prostatectomy using the combined grading of Gleason and Helpap, which allows an exact differentiation particularly of low and intermediate grade tumors. Additionally, we attached time-interval and percentage value of recurrences of prostate-specific antigen (PSA) as well as death on disease (DoD) to the prognostic grade grouping.

Carcinomas of group I/V are very low-grade tumors with very good prognosis without biochemical recurrence and DoD predestining for active surveillance (AS). The group II/V with low progress of PSA without DoD allows the options of an active treatment or AS and shows a prognostic separation of the intermediate group III/V. Within the high-grade groups, a differentiation is necessary between GS 7b (4 + 3), 8, and 9-10 regarding TNM staging and rate of DoD. Prognosis of GS 7b (4 + 3) group III/V is more favourable without DoD in contrast to group IV and V/V with cases of DoD.

Morphologically prognostic classification by using combined grading may improve the prognostic stratification of patients with PCa.