title: Revised Gleason grading system is a better predictor of indolent prostate cancer at the time of diagnosis: retrospective clinical-pathological study on matched biopsy and radical prostatectomy specimens.
abstract: BACKGROUND
  The increase of prostate cancer diagnosis after the introduction of prostate-specific antigen (PSA) screening resulted in overtreatment of patients with low risk tumors. The histological Gleason score (GS) revised in 2005 by the International Society of Urological Pathology (ISUP) is currently the most reliable tool to separate aggressive from indolent prostate cancer.
  
  
  METHODS
  Using the new 2005 GS criteria we retrospectively evaluated biopsy and surgical samples of 1344 patients who underwent radical prostatectomy in our institution. According to the new GS criteria we then selected 134 patients who would have been suitable for active surveillance at the time of biopsy (at least 2 positive cores, PSA < 10 ng/mL, GS ≤ 6). We finally assessed the accuracy of the revised GS in biopsy to predict indolent cancer in the prostatectomy specimens.
  
  
  RESULTS
  The mean GS increased from 6 to 7 after histological revision in biopsy and prostatectomy specimens. Histological revision determined a significant decrease of patients with GS ≤ 6 and an increase of those with GS ≥ 7 (all P < .001). The average of pathologically indolent disease (organ-confined, GS ≤ 6 at surgery, tumor of any volume) significantly decreased after histological revision (P < .001).
  
  
  CONCLUSIONS
  The revised ISUP 2005 criteria for Gleason grading provided better stratification of GS ≤ 6 prostate cancer and improved the accuracy for the histological diagnosis of indolent prostate cancer in biopsy and radical prostatectomy specimens.
authors.affiliation: Pathology Service, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Giunchi
authors.affiliation: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.affiliation: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Rizzi
authors.affiliation: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Martina Sofia
authors.initials: MS
authors.lastname: Ricci
authors.affiliation: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Romagnoli
authors.affiliation: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.affiliation: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Pathology Service, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: michelangelo.fiorentino@aosp.bo.it.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen
keywords: Active surveillance; Gleason grading; Histopathology; Indolent tumor; Prostate cancer