A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score

By Jonathan I. Epstein, M. Zelefsky, D. Sjoberg, J. Nelson, L. Egevad, C. Magi-Galluzzi, Andrew J. Vickers, Anil V. Parwani, V. Reuter, S. Fine and 7 more. European Urology, 2015

1,333 citations recorded by the source corpus.

Background Despite revisions in 2005 and 2014, the Gleason prostate cancer (PCa) grading system still has major deficiencies. Combining of Gleason scores into a three-tiered grouping (6, 7, 8–10) is used most frequently for prognostic and therapeutic purposes. The lowest score, assigned 6, may be misunderstood as a cancer in the middle of the grading scale, and 3 + 4 = 7 and 4 + 3 = 7 are often considered the same prognostic group. Objective To verify that a new grading system accurately produces a smaller number of grades with the most significant prognostic differences, using multi-institutional and multimodal therapy data. Design, setting, and participants Between 2005 and 2014, 20 845 consecutive men were treated by radical prostatectomy at five academic institutions; 5501 men were treated with radiotherapy at two academic institutions. Outcome measurements and statistical analysis Outcome was based on biochemical recurrence (BCR). The log-rank test assessed univariable differences in BCR by Gleason score. Separate univariable and multivariable Cox proportional hazards used four possible categorizations of Gleason scores. Results and limitations In the surgery cohort, we found large differences in recurrence rates between both Gleason 3 + 4 versus 4 + 3 and Gleason 8 versus 9. The hazard ratios relative to Gleason score 6 were 1.9, 5.1, 8.0, and 11.7 for Gleason scores 3 + 4, 4 + 3, 8, and 9–10, respectively. These differences were attenuated in the radiotherapy cohort as a whole due to increased adjuvant or neoadjuvant hormones for patients with high-grade disease but were clearly seen in patients undergoing radiotherapy only. A five–grade group system had the highest prognostic discrimination for all cohorts on both univariable and multivariable analysis. The major limitation was the unavoidable use of prostate-specific antigen BCR as an end point as opposed to cancer-related death. Conclusions The new PCa grading system has these benefits: more accurate grade stratification than current systems, simplified grading system of five grades, and lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa. Patient summary We looked at outcomes for prostate cancer (PCa) treated with radical prostatectomy or radiation therapy and validated a new grading system with more accurate grade stratification than current systems, including a simplified grading system of five grades and a lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa.

Subfields: Pulmonary and Respiratory Medicine, Radiation

View Paper: https://www.semanticscholar.org/paper/d20dff7103c3da6753ef108dc825d9fe44bd00d2

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Citations in the corpus

"Hello AI": Uncovering the Onboarding Needs of Medical Practitioners for Human-AI Collaborative Decision-Making (2019, background): “Pathologists diagnose the severity of prostate cancer through the Gleason scoring system [20].”
Artificial intelligence for diagnosis and Gleason grading of prostate cancer: the PANDA challenge (2022, neutral): “GG 4 768 (15) 481 (9) 19 (10) 30 (15) 16 (5) 22 (10) 21 (3) 19 (6) 1,376 (11)”
Human-Centered Tools for Coping with Imperfect Algorithms During Medical Decision-Making (2019, background): “For example, in prostate cancer diagnosis, pathologists compare evidence to assign a grade (called a Gleason grade [14]), which indicates the most-likely severity of the cancer.”
Automated Gleason grading of prostate cancer tissue microarrays via deep learning (2018, methodology): “Furthermore, in current clinical practice, patients are stratified according to a novel prostate cancer grading system 37 which is based on Gleason grading into five Grade Groups (corresponding to Gleason ≤ 6, Gleason 3 + 4, Gleason 4 + 3, Gleason 8, Gleason 9–10), each with distinct prognosis…”
The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours. (2016, background): “An important point is that intraductal carcinoma is not assigned a Gleason grade [13].”
Artificial intelligence as the next step towards precision pathology (2020, background): “For patients with prostate cancer, the Gleason score is one of the strongest prognostic factors, deﬁning treatment independent of the stage [41].”