Current perspectives on the gleason grading of prostate cancer

Context. - Since its description in 1966 by Donald Gleason, the Gleason grading has remained a cornerstone in the diagnosis and management of prostate cancer. With widespread use of the prostate specific antigen screening, the diagnosis and management patterns of prostate cancers have dramatically changed. In addition, better understanding of the morphologic spectrum of prostate cancer and its subsequent outcome have prompted the refinement of the grading criteria and reporting practices applicable to contemporary practice management. Objective. - To present contemporary perspectives and approaches to the Gleason grading of prostate cancer. Data Sources. - Personal practice experience, review of medical literature, and excerpts from the 2005 International Society of Urological Pathology Consensus Statement on Gleason Grading of Prostate Cancer. Conclusions. - This review addresses the trend in contemporary practice toward a grading shift, with rare utilization of Gleason patterns 1 and 2, and discusses the refinement of histologic criteria for Gleason patterns 3 and 4; approaches to Gleason grading in the setting of unusual variant morphologies of prostate cancer; significance of higher tertiary pattern 5; and practice recommendations for reporting in the setting of extended multiple core biopsies and multifocal prostate cancers in radical prostatectomy. Finally, the impact of consensus recommendations in current practice, its limitations and pitfalls, are also addressed.