Should we abstain from Gleason score 2–4 in the diagnosis of prostate cancer? Results of a German multicentre study

Abstract

The present study shows an independent prognostic impact of GS in biopsy samples classified according to the previous classification. The elimination of GS 2-4 by the ISUP 2005 results in a considerable loss of pretherapeutic prognostic information and therefore should be questioned in particular with regard to the increasing demand for active surveillance regimens.

The Phase 3 COU-AA-302 Study of Abiraterone Acetate Plus Prednisone in Men with Chemotherapy-naïve Metastatic Castration-resistant Prostate Cancer: Stratified Analysis Based on Pain, Prostate-specific Antigen, and Gleason Score

“…In the COU-AA-302 study, half of the samples were from biopsy and half from prostatectomy specimens. Furthermore, the grading system for GS was amended in 2005; therefore, samples taken before 2005 (which applies for some patients in the COU-AA-302 study) may be scored differently from those taken more recently and graded according to the International Society of Urological Pathology modified Gleason grading system [25]. Considerable inter-and intraobserver variation in the assessment of GS has also been noted [26].…”

Das neue ISUP 2014/WHO 2016 Prostatakarzinom-Grading – Status quo 5 Jahre nach seiner Einführung

“…Ziel war es dabei, eine verbesserte Reproduzierbarkeit zwischen Pathologen zu erreichen und den Anteil von Tumoren, der ein sog. "Up-Grading" von der Biopsie hin zum radikalen Prostatektomiepräparat erfährt, zu verringern [3,4].…”