Virchows Archiv

, Volume 449, Issue 6, pp 622–627 | Cite as

The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens

  • Burkhard HelpapEmail author
  • Lars Egevad
Letter to the Editor


At an International Society of Urological Pathology consensus conference in 2005, the Gleason grading system for prostatic carcinoma underwent its first major revision. Gleason pattern 4 now includes most cribriform patterns and also fused and poorly formed glands. Our aims were to compare the grade distributions and assess the agreement between biopsy and radical prostatectomy specimens for the modified and conventional Gleason grading. More than 3,000 radical prostatectomy (RP), needle biopsies (NB) and transurethral resection specimens were assigned modified Gleason score (GS). In NB, modified GS 3 + 3 = 6 and 3 + 4 = 7a were almost equally common, while in RP, 3 + 4 = 7a was most common followed by 4 + 3 = 7b. After application of the modified GS on NB, a substantial shift in GS distribution occurred: The proportion of GS 6 and 7 were 48 and 26%, respectively, with conventional Gleason grading as compared to 22 and 68%, respectively, with modified grading. In 368 men, the agreement between NB and RP with a modified GS 6, 7a, 7b and 8–10 in NB was 28, 88, 68 and 64–100%, respectively. The overall agreement improved from 58 to 72% (p < 0.001) compared to conventional GS. The higher agreement with modified Gleason grading may facilitate therapeutic decisions.


Adenocarcinoma of the prostate Modified Gleason grading Core needle biopsy Radical prostatectomy 


  1. 1.
    Amin M, Boccon-Gibod L, Egevad L, Epstein JI, Humphrey PA, Mikuz G, Newling D, Nilsson S, Sakr W, Srigley JR, Wheeler TM, Montironi R (2005) Prognostic and predictive factors and reporting of prostate carcinoma in prostate needle biopsy specimens. Scand J Urol Nephrol 39:20–33Google Scholar
  2. 2.
    Bonkhoff H (2005) Gleason grading: diagnostic criteria and clinical implications. Pathologe 26:422–432PubMedCrossRefGoogle Scholar
  3. 3.
    Bostwick DG (1994) Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectomies. Am J Surg Pathol 18:796–803PubMedGoogle Scholar
  4. 4.
    Bostwick DG (1994) Grading prostate cancer. Am J Clin Pathol 102:38–59Google Scholar
  5. 5.
    Carlson GD, Calvanese CB, Kahane H, Epstein JI (1998) Accuracy of biopsy Gleason scores from a large uropathology laboratory: use of a diagnostic protocol to minimize observer variability. Urology 51:525–529PubMedCrossRefGoogle Scholar
  6. 6.
    Cookson MS, Fleshner NE, Soloway SM, Fair WR (1997) Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol 157:559–562PubMedCrossRefGoogle Scholar
  7. 7.
    Dunn RL, Shah R, Zhou M (2002) Global Gleason score, highest Gleason score, or weighted Gleason score: what Gleason score should be reported in prostate needle biopsies. Mod Pathol 15:161A–669AGoogle Scholar
  8. 8.
    Egevad L, Allsbrook WC, Epstein JI (2005) Current practice of Gleason grading among genitourinary pathologists. Hum Pathol 36:5–9PubMedCrossRefGoogle Scholar
  9. 9.
    Egevad L, Granfors T, Karlberg L, Bergh A, Stattin P (2002) Percent gleason grade 4/5 as prognostic factor in prostate cancer diagnosed at transurethral resection. J Urol 168:509–513PubMedCrossRefGoogle Scholar
  10. 10.
    Egevad L, Granfors T, Karlberg L, Bergh A, Stattin P (2002) Prognostic value of the Gleason score in prostate cancer. BJU Int 89:538–542PubMedCrossRefGoogle Scholar
  11. 11.
    Egevad L, Norlen BJ, Norberg M (2001) The value of multiple core biopsies for predicting the Gleason score of prostate cancer. BJU Int 88:716–721PubMedCrossRefGoogle Scholar
  12. 12.
    Epstein JI (2000) Gleason score 2–4 adenocarcinoma of the prostate on needle biopsy: a diagnosis that should not be made. Am J Surg Pathol 24:477–478PubMedCrossRefGoogle Scholar
  13. 13.
    Epstein H, Algaba F, Allbrook WC et al (2004) Acinar adenocarcinoma. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA (eds) World Health Organization classification of tumors. Pathology and genetics: tumours of the urinary system and male genital organs. IARC, Lyon, France, pp 179–184Google Scholar
  14. 14.
    Epstein JI, Allsbrook WC, Amin MB, Egevad L, and the ISUP Grading Committee (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29(9):1228–1242PubMedCrossRefGoogle Scholar
  15. 15.
    Gallee MP, Ten Kate FJ, Mulder PG, Blom JH, van der Heul RO (1990) Histological grading of prostatic carcinoma in prostatectomy specimens. Comparison of prognostic accuracy of five grading systems. Br J Urol 65:368–375PubMedCrossRefGoogle Scholar
  16. 16.
    Garnett JE, Oyasu R, Grayhack JT (1984) The accuracy of diagnostic biopsy specimens in predicting tumor grades by Gleason’s classification of radical prostatectomy specimens. J Urol 131:690–693PubMedGoogle Scholar
  17. 17.
    Gaudin PB, Epstein JI (1995) Adenosis of the prostate. Histologic features in needle biopsy specimens. Am J Surg Pathol 19:737–747PubMedCrossRefGoogle Scholar
  18. 18.
    Glaessgen A, Hamberg H, Pihl CG, Sundelin B, Nilsson B, Egevad L (2002) Interobserver reproducibility of percent Gleason grade 4/5 in total prostatectomy specimens. J Urol 168:2006–2010PubMedCrossRefGoogle Scholar
  19. 19.
    Gleason DF (1966) Classification of prostatic carcinomas. Cancer Chemother (Rep Part) 50:125–128Google Scholar
  20. 20.
    Gleason DF (1977) Histologic grading and clinical staging of prostatic carcinoma. In: Tannenbaum M (ed) Urologic Pathology: the prostate. Lea and Felbiger, Philadelphia, pp 171–198Google Scholar
  21. 21.
    Gleason DF (1992) Histological grading of prostate cancer: a perspective. Hum Pathol 23:273–279PubMedCrossRefGoogle Scholar
  22. 22.
    Gleason DF, Mellinger GT (1974) Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol 111:58–64PubMedGoogle Scholar
  23. 23.
    Helpap B (1993) Review of the morphology of prostatic carcinoma with special emphasis on subgrading and prognosis. J Urol Pathol 1:3–20Google Scholar
  24. 24.
    Helpap B (2005) Small suggestive lesions of the prostate. Histological and immunohistochemical analyses—report of the uropathology consultation service. Pathologe 26:398–404PubMedCrossRefGoogle Scholar
  25. 25.
    Helpap B, Böcking A, Dhom G, Kastendiek R, Leistenschneider W, Müller HA (1985) Klassifikation, histologisches und zytologisches Grading sowie Regressionsgrading des Prostatakarzinoms. Eine Empfehlung des pathologisch-urologischen Arbeitskreises “Prostatakarzinoms”. Pathologe 6:3–7PubMedGoogle Scholar
  26. 26.
    Herman CM, Kattan MW, Scardino PT, Wheeler TW (1999) Predominant Gleason pattern is a significant predictor of disease progression in Gleason score 7 prostate cancer. Mod Pathol 12:97AGoogle Scholar
  27. 27.
    Kramer SA, Spahr J, Brendler CB, Glenn JF, Paulson DF (1980) Experience with Gleason’s histopathologic grading in prostatic cancer. J Urol 124:223–225PubMedGoogle Scholar
  28. 28.
    Lang PH, Narayan P (1983) Understaging and undergrading of prostate cancer. Argument for postoperative radiation of adjuvant therapy. Urology 21:113–118CrossRefGoogle Scholar
  29. 29.
    Mellinger GT (1977) Prognosis of prostatic carcinoma. Recent Results Cancer Res 61–72Google Scholar
  30. 30.
    Mellinger GT, Gleason DF, Bailar J 3rd (1967) The histology and prognosis of prostatic cancer. J Urol 97:331–337PubMedGoogle Scholar
  31. 31.
    Mills SE, Fowler JE (1986) Gleason histologic grading of prostatic carcinoma. Correlations between biopsy and prostatectomy specimens. Cancer 57:346–349PubMedCrossRefGoogle Scholar
  32. 32.
    Mosse CA, Magi-Galluzzi C, Tsuzuki T, Epstein JI (2004) The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol 28:394–398PubMedCrossRefGoogle Scholar
  33. 33.
    Mostofi FK, Sesterhenn IA, Davis CJ (2002) Histological typing of prostate tumours. In: World Health Organization international histological classification of tumours. Springer, Berlin Heidelberg New YorkGoogle Scholar
  34. 34.
    Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, Scardino PT, Pearson JD (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer: a multi-institutional update. JAMA 277:1445–1451PubMedCrossRefGoogle Scholar
  35. 35.
    Spires SE, Cibull ML, Wood DP Jr, Miller S, Spires SM, Banks ER (1994) Gleason histologic grading in prostatic carcinoma. Correlation of 18-gauge core biopsy with prostatectomy. Arch Pathol Lab Med 118:705–708PubMedGoogle Scholar
  36. 36.
    Stamey TA, McNeal JE, Freiha FS, Redwine E (1988) Morphometric and clinical studies on 68 consecutive radical prostatectomies. J Urol 139:1235–1241PubMedGoogle Scholar
  37. 37.
    Steinberg DM, Sauvageot J, Piantadosi S, Epstein JI (1997) Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. Am J Surg Pathol 21:566–576PubMedCrossRefGoogle Scholar
  38. 38.
    Young RH, Srigley JR, Amin MB, Ulbright TM, Cubilla AL (2000) Tumors of the prostate gland, seminal vesicles, male urethra, and penis. In: Rosai J, Sobin LH (eds) Atlas of tumor pathology. AFIP, Washington, pp 111–216Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Pathology, Center of Uropathology, General Hospital Hegau-Bodensee-Klinikum SingenAcademic Hospital of the University of FreiburgSingenGermany
  2. 2.Department of Pathology and CytologyKarolinska HospitalStockholmSweden
  3. 3.International Agency for Research on Cancer (IARC)LyonsFrance

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