Buenos Aires, Argentina (UroToday.com) Makarand Khochikar, Siddhi Vinayak Ganapati Cancer Hospital in Miraj, India discussed the revised Gleason grading system and implications. The revised 5-tiered system provides an assessment using prior Gleason scoring except rather than adding primary and secondary Gleason grades in into scores 6 to 10 the revised scoring is 1 to 5. The purpose for this revision is to alleviate patient/provider fear of diagnosis of cancer and associated fear for Gleason score 6. Moreover, the revised system separates prior clinically significant tumors into separate categories such as 3+4, 4+3, 8 and 9. The revised scoring system has been validated in large multi-institutional cohorts with excellent concordance at discerning biochemical recurrence according to the 5 groups. Both the ‘old’ and revised scoring system are being incorporated into pathology reports and it remains to be determined whether the revised system alone will be sufficient to alleviate patient/provider concerns of cancer diagnosis. Furthermore, the revised system will hopefully increase active surveillance and limit over treatment of clinically insignificant disease. Given the simplicity of the conversion to the revised scoring system with further simplicity of scoring 1-5, adoption should not be an issue. The revised scoring system is not perfect and in particular the Group 4 (Gleason 8’s 4+4, 5+3, 3+5) as further subgrouping is likely needed.
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Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.