Changes in prostate cancer grading: Including a new patient‐centric grading system

Abstract

The first structured approach to grade prostate cancer based on the underlying histological architecture was developed by Donald Gleason who in 1966 proposed a morphologic classification of prostate cancer and in 1974 demonstrated its clinical significance based on prostate cancer-specific death. Contemporarily referred to as the Gleason grading system, it has gained worldwide recognition allowing a more individualized approach to patients with prostate cancer. In 2005, the International Society of Urologic Pathology (ISUP) made the first revisions to the grading system. Subsequently, based on the new discoveries in pathologic and clinical aspects of prostate cancer, as well as the changing nature of the prostate cancer in part due to a robust screening, there was a need for experts to re-visit the approach to grade prostate cancer. In November 2014, the ISUP experts and clinical leaders in prostate cancer from 17 countries conducted a consensus conference in Chicago, IL, USA. The consensus conference defined various grade patterns and proposed the adoption of a new grading system of prostate cancer. Herein, we describe the background and rationale for the changes and provide guidelines to their clinical implementation.

Multiparametric dynamic contrast-enhanced ultrasound imaging of prostate cancer

“…The Gleason score, which comprises the grade of the two most prevalent histological patterns found in a stained prostate tissue slice, is an indicator of the stage and aggressiveness of prostatic carcinoma [56, 57]. Following recent consensus in prostate grading, Gleason rate score 3 + 3 is rated as grade group 1, indicating very low-risk disease with high survival rates and virtually no chance of metastasis [58, 59]. We believe that the use of a diverse training set (i.e.…”

A Low Score in Patients with a Positive PCA3 Urine Test Predicts the Lowest Prognostic Category in the New Grading System for Prostate Carcinoma

“…When a biopsy was performed, the number of cylinders obtained was also recorded, and when a PCa was diagnosed, the number of affected cylinders, the percentage of tumor, the Gleason score, and the Grade Group were recorded as well. In those cases diagnosed as PCa before publication of the Gleason Grade Group guidelines, the Gleason score was converted to its corresponding Grade Group according to published instructions [12][13][14].…”

“…The diagnostic entities covered were: prostate adenocarcinoma (PCa), atypical small acinar proliferation (ASAP), high-grade prostatic intraepithelial neoplasia (HGPIN), chronic prostatitis, other nonneoplastic processes, and normality. In PCa cases the grade was determined based on the Gleason patterns and the Grade Group [12][13][14]18]. The new ISUP grading system for prostatic adenocarcinoma classifies PCa into five prognostically distinct Grade Groups (1-5) [12].…”

“…The purpose of this study was to evaluate the yield of PCA3 as an additional test in the management of patients with suspected PCa and to investigate whether our previously published results, in a prospective study of 598 patients, would be confirmed [11]. Moreover, the association of PCA3 with the new Grade Groups proposed by the International Society of Urological Pathology (ISUP) in 2014 was evaluated [12][13][14].…”

Value of the New 5-Tiered Prostate Cancer Grade Group System on Predicting Oncological Outcomes for Radical Prostatectomy Population in Korea

“…In this regard, in 2014, a new grading system for prostate cancer was introduced by the International Society of Urological Pathology (ISUP), which divided the Gleason score into 5 groups. [7][8][9][10] After the introduction of the new 5-tiered grading system, several Western studies validated the predictive role of the new system and reported its superiority over the previous grading systems. 7,9,10 However, the new 5-tiered grading system has not been validated in Asian prostate cancer patients.…”