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Subspecialties Training and education, Oncology

Bad Grades for Gleason

At a Glance

  • Prostate cancer is very common, but also highly variable
  • Current grading systems are needlessly complex and can be difficult for patients to understand – leading to unwarranted anxiety
  • A new grading system stratifies patients into five “Grade Groups” based on histological characteristics
  • The new system has met with broad favor so far, including with the World Health Organization, and it can be used alongside existing Gleason scores

Prostate cancer is the fourth most common cancer in the world – and for men, the second most common cancer. And with incidence rates projected to rise significantly over the next decades, it’s more important than ever to gain a full understanding of this highly variable disease. From vague symptoms to controversial tests (1), it can be difficult to conclusively evaluate a patient’s risk even after diagnosis. Some forms of prostate cancer grow quickly, whereas others may remain indolent for years; some respond well to surgery alone, whereas others may need a range of additional therapies. So how can pathologists determine which prostate cancers present the highest risk – and which patients should be offered more aggressive treatment options? At the moment, the answer relies on classification tools like the Gleason score – but that system was first conceived over 50 years ago and is in desperate need of an update.

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About the Author

Jonathan Epstein

Jonathan Epstein is Professor of Pathology, Urology, and Oncology (Reinhard Chair of Urological Pathology) and Director of Surgical Pathology at the Johns Hopkins Medical Institutions (Baltimore, Maryland, USA).

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