Impact on the Clinical Outcome of Prostate Cancer by the 2005 International Society of Urological Pathology Modified Gleason Grading System
- 1 June 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The American Journal of Surgical Pathology
- Vol. 36 (6), 838-843
- https://doi.org/10.1097/pas.0b013e3182486faf
Abstract
The 2005 International Society of Urological Pathology (ISUP) Consensus Conference modified the Gleason grading system for prostate cancer. In the modified criteria, ill-defined glands with poorly formed lumina and large cribriform glands with smooth borders, classically described as Gleason pattern 3 adenocarcinoma, were redefined as Gleason pattern 4. To evaluate the clinical outcome of patients upgraded by the ISUP criteria, the histologic slides of 1240 consecutive radical prostatectomy specimens at a single institution were reviewed, and each case of adenocarcinoma was graded on the basis of the original and modified Gleason criteria. A total of 806 patients with prostate cancer of classical Gleason score 3+3=6 or 3+4=7 and modified Gleason score 6 to 8 were analyzed with a median overall follow-up of 12.6 years. In the study population, 34% of patients with classical Gleason score 3+3=6 prostate cancer were upgraded to modified Gleason score 7 or 8 by the ISUP criteria. Compared to patients with modified Gleason score 3+3=6 and patients with classical Gleason score 3+4=7, the upgraded patients were at intermediate risk for biochemical progression (paired log-rank P≤0.003) and metastasis (paired log-rank P≤0.04) after radical prostatectomy. The hazard ratio for upgrading was 1.60 (95% confidence interval, 1.09-2.35, P=0.02) for biochemical recurrence and 5.02 (95% confidence interval, 1.77-14.2, P=0.003) for metastasis. These results validate the prognostic value of the modified Gleason grading system and suggest that the recognition of an intermediate-risk histological pattern may be useful in the prognosis of patients with prostate cancer.Keywords
This publication has 18 references indexed in Scilit:
- Predicting 15-Year Prostate Cancer Specific Mortality After Radical ProstatectomyJournal of Urology, 2011
- An Update of the Gleason Grading SystemJournal of Urology, 2010
- The Impact of the 2005 International Society of Urological Pathology Consensus Conference on Standard Gleason Grading of Prostatic Carcinoma in Needle BiopsiesJournal of Urology, 2008
- Pathologic Stage Migration Has Slowed in the Late PSA EraUrology, 2007
- Prostate Cancer and the Will Rogers PhenomenonJNCI Journal of the National Cancer Institute, 2005
- The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic CarcinomaThe American Journal of Surgical Pathology, 2005
- Time Trends in Clinical Risk Stratification for Prostate Cancer: Implications for Outcomes (Data From CaPSURE)Journal of Urology, 2003
- The gleason score shift: score four and seven years agoInternational Journal of Radiation Oncology*Biology*Physics, 2003
- Interobserver reproducibility of Gleason grading of prostatic carcinoma: General pathologistHuman Pathology, 2001
- Correlation of pathologic findings with progression after radical retropubic prostatectomyCancer, 1993