to Benefits and harms of the new prostate cancer grade grouping on the prediction of long-term oncological outcomes in patients after radical prostatectomy Gleason score is one of the most important predictors of prostate cancer prognosis and clinical management. The risk classification model proposed by D'Amico et al. 1 using Gleason score, prostate-specific antigen, and clinical stage has been widely used in the management of localized prostate cancer. However, heterogeneity with regard to intermediate risk classification has long been a concern. Epstein et al. 2 reported a new grade grouping (GG) system to resolve this problem. They identified a prognostic difference between Gleason score 3 + 4 and 4 + 3 and proposed to divide Gleason score 7 into GG3 and GG4, in addition to the previous Gleason score. This system has been commonly used in prostate cancer management and has eliminated some of the prognostic uncertainty associated with the D'Amico intermediate risk classification. Many validations of the new GG system have been performed worldwide, with generally positive results. Because of the long natural history of localized prostate cancer, there are still only few reports on surgical cases with long-term follow-up, based on the new GG system. In one such paper, Milonas et al. 3 report long-term follow-up results, clinical progression, and cancer-specific mortality based on this new GG system. A significant feature of their report was that many patients underwent observation with long time. However, as the number of deaths from prostate cancer was relatively small, further longterm studies would need to be conducted. Another interesting aspect of the study is that all models were significant for cancer-specific mortality. However, high Gleason score was the only independent factor for cancer-specific mortality. Hence, it was suggested that patients with a low Gleason score might have had a more extended follow-up period because they responded well to post-recurrence treatment, or may not die from prostate cancer.Gleason score is still considered to have a significant role as a prognostic factor for biochemical recurrence and cancer-specific mortality. With the development of technologies, better models will be established, such as genetic research and liquid biopsy. Once these are introduced into clinical practice, precision medicine will start playing a leading role in prostate cancer treatment, with treatment methods being selected based entirely on the individual's genetic sequence. In the future, correlations between the Gleason score and various genetic variants may be established. However, Gleason score will continue to play a significant role in the management of prostate cancer in clinical practice.