Experience with Gleason's histopathologic grading in prostatic cancer

Area of Science:

• Oncology
• Urology
• Pathology

Background:

• Clinical staging of prostate cancer is often inaccurate for predicting disease behavior.
• Accurate assessment of biologic potential is crucial for treatment planning.

Purpose of the Study:

• To evaluate the reliability of the Gleason grading system in predicting nodal metastasis in prostate cancer patients.
• To assess the accuracy of pedal lymphangiography in staging prostate cancer.

Main Methods:

• Review of 228 patients with prostatic adenocarcinoma.
• Histopathologic classification using Gleason's grading system.
• Staging pelvic lymphadenectomy performed on 144 patients; some underwent preliminary pedal lymphangiography.

Main Results:

• Gleason's sum of 8-10 correlated with 93% regional nodal metastasis, irrespective of clinical stage.
• No nodal metastasis observed in patients with Gleason's sum of 2-4.
• Pedal lymphangiography showed high false positive (29%) and false negative (35%) rates, indicating unreliability.

Conclusions:

• The Gleason grading system is a reliable predictor of nodal metastasis and surgical stage in prostate cancer.
• Pedal lymphangiography is unreliable for assessing nodal involvement in prostate cancer staging.