Will the Modification of the Gleason Grading System Affect the Urology Practice?

Abstract

The aim of the present study was to determine how the modified Gleason grading (mGG) system affects the score discrepancy between needle biopsy (NB) and radical prostatectomy (RP) and to investigate the effect of the modified scores on nomogram predictions. When the conventional Gleason grading (cGG) and mGG systems were compared, a new Gleason score was obtained in the NBs for 40 out of 97 patients (41.2%; P < .001) and in the RP specimens for 15 out of 97 patients (15.5%; P = .005). The agreement between the NBs and RP specimens rose from 31.9% to 44.3% with the mGG system (P = .017). However, when the predictions calculated with the location of modified Gleason scores in the Memorial Sloan Kettering Cancer Center nomogram were compared with those of the conventional Gleason scores, higher pathological stage and lower life expectancy predictions were obtained. Therefore, when a clinician is making a choice from therapeutic options, this change should be taken into account.

Keywords

nomogram pattern prostate biopsy prostate cancer

Get full access to this article

View all access options for this article.

References

Gleason DF Classification of prostatic carcinomas. Cancer Chemother Rep . 1966;50:125-128.

Mellinger GT , Gleason D. , Bailar J. 3rd. The histology and prognosis of prostatic cancer. J Urol. 1967;97:331-337.

Gleason DF , Mellinger GT ; Veterans Administration Cooperative Urological Research Group. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. 1974. J Urol. 2002;167: 953-958.

Gleason DF Histological grading and clinical staging of prostatic carcinoma. In: Tannenbaum M , ed. Urologic Pathology: The Prostate. Philadelphia, PA: Lea & Feibiger; 1977:171-198.

Epstein JI , Allsbrook WC Jr , Amin MB , Egevad LL ; ISUP Grading Committee. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005;29:1228-1242.

Bostwick DG Grading prostate cancer. Am J Clin Pathol. 1994;102(4 suppl 1):S38-S56.

Steinberg DM , Sauvageot J. , Piantadosi S. , Epstein JI Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. Am J Surg Pathol. 1997;21:566-576.

Brinker DA , Ross JS , Tran TA , Jones DM , Epstein JI Can ploidy of prostate carcinoma diagnosed on needle biopsy predict radical prostatectomy stage and grade? J Urol. 1999 ; 162:2036-2039.

San Francisco IF , DeWolf WC , Rosen S. , Upton M. , Olumi AF Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy . J Urol. 2003;169:136-140.

10.

Djavan B. , Kadesky K. , Klopukh B. , Marberger M. , Roehrborn CG Gleason scores from prostate biopsies obtained with 18-gauge biopsy needles poorly predict Gleason scores of radical prostatectomy specimens. Eur Urol. 1998; 33: 261-270.

11.

Bastian PJ , Gonzalgo ML , Aronson WJ , et al. Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10. Cancer. 2006;107:1265-1272.

12.

Köksal IT , Ozcan F. , Kadioglu TC , Esen T. , Kilicaslan I. , Tunc M. Discrepancy between Gleason scores of biopsy and radical prostatectomy specimens. Eur Urol. 2000;37:670-674.

13.

Cookson MS , Fleshner NE , Soloway SM , Fair WR Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol. 1997;157:559-562.

14.

Ross PL , Scardino PT , Kattan MW A catalog of prostate cancer nomograms. J Urol. 2001;165:1562-1568.

15.

Di Blasio CJ , Rhee AC , Cho D. , Scardino PT , Kattan MW Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol. 2003;30:567-586.

16.

Helpap B. , Egevad L. The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens. Virchows Arch. 2006;449:622-627.

17.

Stamey TA , McNeal JE , Yemoto CM , Sigal BM , Johnstone IM Biological determinants of cancer progression in men with prostate cancer . JAMA. 1999;281:1395-1400.

18.

Partin AW , Kattan MW , Subong EN , et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA. 1997;277:1445-1451.

19.

Partin AW , Mangold LA , Lamm DM , Walsh PC , Epstein JI , Pearson JD Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology. 2001;58:843-848.

20.

Steyerberg EW , Roobol MJ , Kattan MW , van der Kwast TH , de Koning HJ , Schroder FH Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram. J Urol. 2007;177:107-112.

21.

Chun FK , Karakiewicz PI , Briganti A. , et al. Prostate cancer nomograms: an update. Eur Urol . 2006;50:914-926.