Standardization of Gleason grading among 337 European pathologists

Egevad, Lars; Ahmad, Amar; Algaba, Ferrán; Berney, Daniel M.; Boccon‐Gibod, Liliane; Compérat, Eva; Evans, Andrew; Griffiths, David; Grobholz, Rainer; Kristiansen, Glen; Langner, Cord; López-Beltrán, Antonio; Montironi, Rodolfo; Moss, Steve; Oliveira, Pedro; Vainer, Ben; Varma, Murali; Camparo, Philippe

doi:10.1111/his.12008

Cited by 152 publications

(137 citation statements)

References 18 publications

(28 reference statements)

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“…It is a very important task for the pathology community to establish criteria for standardisation of detection thresholds for the identification of high-grade patterns. There was a recent attempt by the European Network of Uropathology, who distributed reference images for testing and calibration of 337 European pathologists [37]. More large-scale image libraries would help to establish a 'gold standard' for contemporary grading.…”

Section: Discussionmentioning

confidence: 99%

Gleason inflation 1998–2011: a registry study of 97 168 men

et al. 2015

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ObjectivesTo study long‐term trends in Gleason grading in a nationwide population and to assess the impact of the International Society of Urological Pathology (ISUP) revision in 2005 of the Gleason system on grading practices, as in recent years there has been a shift upwards in Gleason grading of prostate cancer.Patients and MethodsAll newly diagnosed prostate cancers in Sweden are reported to the National Prostate Cancer Register (NPCR). In 97 168 men with a primary diagnosis of prostate cancer on needle biopsy from 1998 to 2011, Gleason score, clinical T stage (cT) and serum levels of prostate‐specific antigen (s‐PSA) at diagnosis were analysed.ResultsGleason score, cT stage and s‐PSA were reported to the NPCR in 97%, 99% and 99% of cases. Before and after 2005, Gleason score 7–10 was diagnosed in 52% and 57%, respectively (P < 0.001). After standardisation for cT stage and s‐PSA with 1998 as baseline these tumours increased from 59% to 72%. Among low‐risk tumours (stage cT1and s‐PSA 4–10 ng/mL) Gleason score 7–10 increased from 16% in 1998 to 40% in 2011 (P trend < 0.001), mean 19% and 33% before and after 2005 (P < 0.001). Among high‐risk tumours (stage T3 and s‐PSA 20–50 ng/mL) Gleason score 7–10 increased from 65% in 1998 to 94% in 2011 (P trend < 0.001), mean 78% and 90% before and after 2005 (P < 0.001). A Gleason score of 2–5 was reported in 27% in 1998 and 1% in 2011. Gleason score 5 decreased sharply after 2005 and Gleason score 2–4 was almost abandoned.ConclusionsThere has been a gradual shift towards higher Gleason grading, which started before 2005 but became more evident after the ISUP 2005 revision. Among low‐stage tumours reporting of Gleason score 7–10 was more than doubled during the study period. When corrected for stage migration upgrading is considerable over recent decades. This has clinical consequences for therapy decisions such as eligibility for active surveillance. Grading systems need to be as stable as possible to enable comparisons over time and to facilitate the interpretation of the prognostic impact of grade.

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Section: Discussionmentioning

confidence: 99%

Gleason inflation 1998–2011: a registry study of 97 168 men

et al. 2015

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“…Due to known interobserver variability associated with the identification of minor Gleason pattern 4 elements, prospective intradepartmental consultation with colleagues should be considered a cornerstone of quality assurance in this area. 26,27 Pathologists should use uniform methodology when assessing and reporting the extent of cancer involvement in biopsy cores, especially when dealing with discontinuously involved cores 26 since volume and distribution of disease in prostate biopsies are also selection criteria for AS.…”

Section: Recommendationmentioning

confidence: 99%

“…27 An RCT comparing RP to watchful waiting found that RP reduced the risk of distant metastases and reduced prostate cancer mortality rates. 44 In 6 studies, 17% to 31% of patients undergoing AS were reclassified to a higher risk group over time.…”

Section: Recommendationmentioning

confidence: 99%

Active surveillance for the management of localized prostate cancer: Guideline recommendations

Morash

Tey

Agbassi

et al. 2015

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Introduction: The objective is to provide guidance on the role of active surveillance (AS) as a management strategy for low-risk prostate cancer patients and to ensure that AS is offered to appropriate patients assessed by a standardized protocol. Prostate cancer is often a slowly progressive or sometimes non-progressive indolent disease diagnosed at an early stage with localized tumours that are unlikely to cause morbidity or death. Standard active treatments for prostate cancer include radiotherapy (RT) or radical prostatectomy (RP), but the harms from over diagnosis and overtreatment are of a significant concern. AS is increasingly being considered as a management strategy to avoid or delay the potential harms caused by unnecessary radical treatment. Methods: A literature search of MEDLINE, EMBASE, the Cochrane library, guideline databases and relevant meeting proceedings was performed and a systematic review of identified evidence was synthesized to make recommendations relating to the role of AS in the management of localized prostate cancer. Results: No exiting guidelines or reviews were suitable for use in the synthesis of evidence for the recommendations, but 59 reports of primary studies were identified. Due to studies being either non-comparative or heterogeneous, pooled meta-analyses were not conducted. Conclusion:The working group concluded that for patients with low-risk (Gleason score ≤6) localized prostate cancer, AS is the preferred disease management strategy. Active treatment (RP or RT) is appropriate for patients with intermediate-risk (Gleason score 7) localized prostate cancer. For select patients with low-volume Gleason 3+4=7 localized prostate cancer, AS can be considered.

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“…Unfortunately, while PSA screening detects many additional cases of disease, it has poor specificity, and has produced an increasing problem in separating aggressive from indolent cancers [2,3]. Currently, the best-available prognostic tool for routine management is Gleason score [4], but drawbacks such as intra-and interobserver variability [5] as well as variability due to the difficulty of targeting needle biopsies precisely to the cancer leads to errors in sampling and visual scoring. The weakness of current tools for specifically identifying aggressive disease means that men today still face a dilemma when choosing between treatments or watchful waiting.…”

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confidence: 99%