title: Impact on the clinical outcome of prostate cancer by the 2005 international society of urological pathology modified Gleason grading system.
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.
authors.affiliation: Department of Pathology, Biostatistics Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Fei
authors.initials: F
authors.lastname: Dong
authors.forename: Chaofu
authors.initials: C
authors.lastname: Wang
authors.forename: A Brad
authors.initials: AB
authors.lastname: Farris
authors.forename: Shulin
authors.initials: S
authors.lastname: Wu
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Aria F
authors.initials: AF
authors.lastname: Olumi
authors.forename: W Scott
authors.initials: WS
authors.lastname: McDougal
authors.forename: Robert H
authors.initials: RH
authors.lastname: Young
authors.forename: Chin-Lee
authors.initials: CL
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate