Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have their diagnosis made on needle biopsies. Treatment choices ranging from active surveillance to radical prostatectomy or radiation therapy are largely driven by the pathological findings in the biopsy specimen. Since prostate cancer histology plays a critical role in predicting patient outcomes, attempts have been made to refine histological classification and reporting in prostate cancer to facilitate patient risk stratification. Nearly half a century ago pathologist Donald Gleason developed a grading system for prostatic adenocarcinomas which was almost universally embraced for grading and reporting of prostatic cancers. Over the years, the system has been modified by Gleason and his collaborators and by others. As a result, the grading of prostatic carcinomas has evolved substantially over a period of time to increase its prognostic impact, to reduce interobserver variation and to improve concordance between needle biopsy and radical prostatectomy.
The talk provides an overview of changes in prostatic cancer grading over a period of time. The first part of the talk focuses on the historical perspective, old Gleason grading system and the ISUP 2005 update. The second part of the talk discusses changes made in the new Gleason grading system in 2016 & 2019.