The Experts below are selected from a list of 13638 Experts worldwide ranked by ideXlab platform
Jonathan I Epstein - One of the best experts on this subject based on the ideXlab platform.
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The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer.
Archives of pathology & laboratory medicine, 2020Co-Authors: Jonathan I Epstein, Mahul B. Amin, Ferran Algaba, Manju Aron, Dilek Ertoy Baydar, Antonio Lopez Beltran, Fadi Brimo, John C. Cheville, Samson W. Fine, Maurizio ColecchiaAbstract:Context.— Controversies and uncertainty persist in prostate Cancer Grading. Objective.— To update Grading recommendations. Data Sources.— Critical review of the literature along with pathology and ...
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How Are Gleason Scores Categorized in the Current Literature: An Analysis and Comparison of Articles Published in 2016-2017.
European urology, 2018Co-Authors: Amy G. Zhou, Daniela C. Salles, Iryna Samarska, Jonathan I EpsteinAbstract:Abstract Background A new prostate Cancer Grading system was proposed in 2013 and endorsed by major journals and societies in 2014, in part because of anecdotal evidence that Gleason scores (GSs) were incorrectly combined in the literature. Objective To examine how published studies categorized GSs in current practice. Design, setting, and participants A PubMed search was conducted on articles published in 2016–2017 using the search terms “Gleason” and “prostate”. This literature review included 1576 articles after exclusions. Results (1) Separating GS 7: pathology journals were more likely than non-pathology journals to grade GS 7 separately (56.9% vs 40.0%, p Conclusions There is still wide variation in how GSs are grouped world-wide. Only a minority of published articles group GSs accurately. Patient summary In this report, we looked at how GSs were grouped world-wide. We found that only a minority of published articles on prostate Cancer were grouping GSs accurately, which could lead to inaccurate results and affect patient care with different prostate Cancer grades. Our study calls for more widespread adoption of the new prostate Cancer Grading system composed of five grade groups to minimize incorrect grouping for future studies.
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Prostate Cancer Grading: a decade after the 2005 modified system
Modern Pathology, 2018Co-Authors: Jonathan I EpsteinAbstract:This review article will cover the evolution of Grading of prostate Cancer from the original Gleason system in the 1960–1970s to a more patient-centric Grading system proposed in 2013 from a group at Johns Hopkins Hospital, validated in 2014 by a large multi-institutional study, and subsequently accepted by the World Health Organization (WHO), College of American Pathology (CAP), and the AJCC TNM system. Covered topics include: (1) historical background; (2) 2005 and 2014 International Society of Urological Pathology Grading Conferences; (3) Description of Gleason patterns; (4) new approaches to display Gleason grades; (5) Grading variants and variations of acinar adenocarcinoma; (6) reporting rules for Gleason Grading reporting secondary patterns of higher grade when present to a limited extent; (7) reporting secondary patterns of lower grade when present to a limited extent; (8) reporting percentage pattern 4; (9) general applications of the Gleason Grading system; (10) needle biopsy with different cores showing different grades; (11) radical prostatectomy specimens with separate tumor nodules; and (12) a new Grading system for prostate Cancer.
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new prostate Cancer Grading system predicts long term survival following surgery for gleason score 8 10 prostate Cancer
European Urology, 2017Co-Authors: Won Sik Ham, Heather J Chalfin, Zhaoyong Feng, Bruce J Trock, Jonathan I Epstein, Carling Cheung, Elizabeth B Humphreys, Alan W Partin, Misop HanAbstract:Abstract Background The newly proposed five-tiered prostate Cancer Grading system (PCGS) divides Gleason score (GS) 8–10 disease into GS 8 and GS 9–10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes. Objective To assess the significance of distinguishing GS 8 versus 9–10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS. Design, setting, and participants Of 23918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8–10, and 1047 men with RP GS 8–10. Outcome measures and statistical analysis Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9–10. We compared all-cause mortality (ACM) and prostate Cancer–specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event. Results and limitations Compared to men with GS 8, men with GS 9–10 had later RP year and higher pathologic stage. Among men with Bx GS 8–10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1–7) for both overall and Cancer-specific survival. Of men with RP GS 8–10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2–8) and 4 yr (IQR 2–9) for overall and Cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9–10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37–3.30; p p Conclusions Men with GS 9–10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9–10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS. Patient summary The prostate Cancer Grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason score 8–10 disease based on both biopsy and RP Gleason scores. There are significant differences in all-cause mortality and prostate Cancer–specific mortality following surgery between men with Gleason score 8 and those with Gleason score 9–10 disease.
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New Prostate Cancer Grading System Predicts Long-term Survival Following Surgery for Gleason Score 8–10 Prostate Cancer
European urology, 2016Co-Authors: Won Sik Ham, Heather J Chalfin, Zhaoyong Feng, Bruce J Trock, Jonathan I Epstein, Carling Cheung, Elizabeth B Humphreys, Alan W Partin, Misop HanAbstract:Abstract Background The newly proposed five-tiered prostate Cancer Grading system (PCGS) divides Gleason score (GS) 8–10 disease into GS 8 and GS 9–10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes. Objective To assess the significance of distinguishing GS 8 versus 9–10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS. Design, setting, and participants Of 23918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8–10, and 1047 men with RP GS 8–10. Outcome measures and statistical analysis Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9–10. We compared all-cause mortality (ACM) and prostate Cancer–specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event. Results and limitations Compared to men with GS 8, men with GS 9–10 had later RP year and higher pathologic stage. Among men with Bx GS 8–10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1–7) for both overall and Cancer-specific survival. Of men with RP GS 8–10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2–8) and 4 yr (IQR 2–9) for overall and Cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9–10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37–3.30; p p Conclusions Men with GS 9–10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9–10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS. Patient summary The prostate Cancer Grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason score 8–10 disease based on both biopsy and RP Gleason scores. There are significant differences in all-cause mortality and prostate Cancer–specific mortality following surgery between men with Gleason score 8 and those with Gleason score 9–10 disease.
Katia R. M. Leite - One of the best experts on this subject based on the ideXlab platform.
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Prostate Cancer Grading, time to go back to the future.
BJU international, 2020Co-Authors: Lars Egevad, Brett Delahunt, David G. Bostwick, Andrew Evans, Liang Cheng, Troy Gianduzzo, Markus Graefen, Jonas Hugosson, James G. Kench, Katia R. M. LeiteAbstract:In November 2014, the International Society of Urological Pathology (ISUP) convened a consensus meeting in Chicago, USA to consider Grading criteria for prostatic adenocarcinoma [1]. The primary purpose and main outcome of this meeting was a recommendation that not only should the Gleason score of prostate Cancer be reported but that Grading should also incorporate a 5-tier grade based on a grouping of Gleason scores. The outcome of the conference has resulted in widespread confusion as to the Grading nomenclature. This has weighed heavily on the prostate Cancer literature to the extent that the time has now come to question the scientific value of the score grouping.
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controversial issues in gleason and international society of urological pathology isup prostate Cancer Grading proposed recommendations for international implementation
Pathology, 2019Co-Authors: John R Srigley, Brett Delahunt, Hemamali Samaratunga, Andrew Evans, Liang Cheng, James G. Kench, Athanase Billis, David Clouston, Bungo Furusato, Katia R. M. LeiteAbstract:The Gleason Grading system has been used for over 50 years to prognosticate and guide the treatment for patients with prostate Cancer. At consensus conferences in 2005 and 2014 under the guidance of the International Society of Urological Pathology (ISUP), the system has undergone major modifications to reflect modern diagnostic and therapeutic practices. The 2014 consensus conference yielded recommendations regarding cribriform, mucinous, glomeruloid and intraductal patterns, the most significant of which was the removal of any cribriform pattern from Gleason grade 3. Furthermore, a Gleason score grouping system was endorsed which consisted of five grades where Gleason score 6 (3+3) was classified as grade 1 which better reflected the mostly indolent behaviour of these tumours. Another issue discussed at the meeting and subsequently endorsed was that in Gleason score 7 cases, the percentage pattern 4 should be recorded. This is especially important in situations where modern active surveillance protocols expand to include men with low volume pattern 4. While major progress was made at the conference, several issues were either not resolved or not discussed at all. Most of these items relate to details of assignment of Gleason score and ISUP grade in specific specimen types and Grading scenarios. This detailed review looks at the 2014 ISUP conference results and subsequent literature from an international perspective and proposes several recommendations. The specific issues addressed are percentage pattern 4 in Gleason score 7 tumours, percentage patterns 4 and 5 or 4/5 in Gleason score 8-10 disease, minor (≤5%) high grade patterns when either 2 or 3 patterns are present, level of reporting (core, specimen, case), dealing with grade diversity among site (highest and composite scores) and reporting scores in radical prostatectomy specimens with multifocal disease. It is recognised that for many of these issues, a strong evidence base does not exist, and further research studies are required. The proposed recommendations mostly reflect consolidated expert opinion and they are classified as established if there was prior agreement by consensus and provisional if there was no previous agreement or if the item was not discussed at prior consensus conferences. For some items there are reporting options that reflect the local requirements and diverse practice models of the international urological pathology community. The proposed recommendations provide a framework for discussion at future consensus meetings.
Lars Egevad - One of the best experts on this subject based on the ideXlab platform.
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Interobserver reproducibility of perineural invasion of prostatic adenocarcinoma in needle biopsies
Virchows Archiv, 2021Co-Authors: Lars Egevad, Brett Delahunt, Hemamali Samaratunga, Toyonori Tsuzuki, Henrik Olsson, Peter Ström, Cecilia Lindskog, Tomi Häkkinen, Kimmo Kartasalo, Martin EklundAbstract:Numerous studies have shown a correlation between perineural invasion (PNI) in prostate biopsies and outcome. The reporting of PNI varies widely in the literature. While the interobserver variability of prostate Cancer Grading has been studied extensively, less is known regarding the reproducibility of PNI. A total of 212 biopsy cores from a population-based screening trial were included in this study (106 with and 106 without PNI according to the original pathology reports). The glass slides were scanned and circulated among four pathologists with a special interest in urological pathology for assessment of PNI. Discordant cases were stained by immunohistochemistry for S-100 protein. PNI was diagnosed by all four observers in 34.0% of cases, while 41.5% were considered to be negative for PNI. In 24.5% of cases, there was a disagreement between the observers. The kappa for interobserver variability was 0.67–0.75 (mean 0.73). The observations from one participant were compared with data from the original reports, and a kappa for intraobserver variability of 0.87 was achieved. Based on immunohistochemical findings among discordant cases, 88.6% had PNI while 11.4% did not. The most common diagnostic pitfall was the presence of bundles of stroma or smooth muscle. It was noted in a few cases that collagenous micronodules could be mistaken for a nerve. The distance between Cancer and nerve was another cause of disagreement. Although the results suggest that the reproducibility of PNI may be greater than that of prostate Cancer Grading, there is still a need for improvement and standardization.
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Prostate Cancer Grading, time to go back to the future.
BJU international, 2020Co-Authors: Lars Egevad, Brett Delahunt, David G. Bostwick, Andrew Evans, Liang Cheng, Troy Gianduzzo, Markus Graefen, Jonas Hugosson, James G. Kench, Katia R. M. LeiteAbstract:In November 2014, the International Society of Urological Pathology (ISUP) convened a consensus meeting in Chicago, USA to consider Grading criteria for prostatic adenocarcinoma [1]. The primary purpose and main outcome of this meeting was a recommendation that not only should the Gleason score of prostate Cancer be reported but that Grading should also incorporate a 5-tier grade based on a grouping of Gleason scores. The outcome of the conference has resulted in widespread confusion as to the Grading nomenclature. This has weighed heavily on the prostate Cancer literature to the extent that the time has now come to question the scientific value of the score grouping.
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Evolution, controversies and the future of prostate Cancer Grading.
Pathology international, 2019Co-Authors: Lars Egevad, Brett Delahunt, John Yaxley, Hemamali SamaratungaAbstract:Histological Grading of prostate Cancer is one of the most important tissue-based parameters for prediction of outcome and treatment response. Gleason Grading remains the foundation of prostate Cancer Grading, but has undergone a series of changes in the past 30 years, often initiated by consensus conference decisions. This review summarizes the most important modifications that were introduced by the 2005 and 2014 International Society of Urological Pathology (ISUP) revisions of Gleason Grading and discusses the impact that these have had on current Grading practices. A considerable inflation in Gleason scores has been observed, especially following the ISUP 2005 revision, and the effects of this are discussed. ISUP 2014 Grading recommendations are described, including the reporting of ISUP grades 1-5. Controversial issues include methods for reporting of grades on needle biopsies, reporting of percent Gleason grades 4/5 and Grading of cribriform and intraductal carcinoma of the prostate. Educational programs developed recently to promote standardization of Grading are described and their results assessed.
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utility of pathology imagebase for standardisation of prostate Cancer Grading
Histopathology, 2018Co-Authors: Lars Egevad, E Delahu, Daniel M Erney, David G Ostwick, Joh C Cheville, Eva Compera, Andrew Evans, Samso W Fine, David J Grigno, Pete A HumphreyAbstract:Aims: Despite efforts to standardise Grading of prostate Cancer, even among experts there is still a considerable variation in Grading practices. In this study we describe the use of Pathology Imagebase, a novel reference image library, for setting an international standard in prostate Cancer Grading. Methods and results: The International Society of Urological Pathology (ISUP) recently launched a reference image database supervised by experts. A panel of 24 international experts in prostate pathology reviewed independently microphotographs of 90 cases of prostate needle biopsies with Cancer. A linear weighted kappa of 0.67 (95% confidence interval = 0.62-0.72) and consensus was reached in 50 cases. The interobserver weighted kappa varied from 0.48 to 0.89. The highest level of agreement was seen for Gleason score (GS) 3 + 3 = 6 (ISUP grade 1), while higher grades and particularly GS 4 + 3 = 7 (ISUP grade 3) showed considerable disagreement. Once a two-thirds majority was reached, images were moved automatically into a public database available for all ISUP members at www.isupweb.org. Non-members are able to access a limited number of cases. Conclusions: It is anticipated that the database will assist pathologists to calibrate their Grading and, hence, decrease interobserver variability. It will also help to identify instances where definitions of grades need to be clarified.
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a contemporary prostate Cancer Grading system a validated alternative to the gleason score
European Urology, 2016Co-Authors: Jonathan I Epstein, Lars Egevad, Michael J Zelefsky, Daniel Sjoberg, Joel B Nelson, Cristina Magigalluzzi, Andrew J Vickers, Anil V Parwani, Victor E Reuter, Samson W. FineAbstract:Abstract 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.
Brett Delahunt - One of the best experts on this subject based on the ideXlab platform.
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Interobserver reproducibility of perineural invasion of prostatic adenocarcinoma in needle biopsies
Virchows Archiv, 2021Co-Authors: Lars Egevad, Brett Delahunt, Hemamali Samaratunga, Toyonori Tsuzuki, Henrik Olsson, Peter Ström, Cecilia Lindskog, Tomi Häkkinen, Kimmo Kartasalo, Martin EklundAbstract:Numerous studies have shown a correlation between perineural invasion (PNI) in prostate biopsies and outcome. The reporting of PNI varies widely in the literature. While the interobserver variability of prostate Cancer Grading has been studied extensively, less is known regarding the reproducibility of PNI. A total of 212 biopsy cores from a population-based screening trial were included in this study (106 with and 106 without PNI according to the original pathology reports). The glass slides were scanned and circulated among four pathologists with a special interest in urological pathology for assessment of PNI. Discordant cases were stained by immunohistochemistry for S-100 protein. PNI was diagnosed by all four observers in 34.0% of cases, while 41.5% were considered to be negative for PNI. In 24.5% of cases, there was a disagreement between the observers. The kappa for interobserver variability was 0.67–0.75 (mean 0.73). The observations from one participant were compared with data from the original reports, and a kappa for intraobserver variability of 0.87 was achieved. Based on immunohistochemical findings among discordant cases, 88.6% had PNI while 11.4% did not. The most common diagnostic pitfall was the presence of bundles of stroma or smooth muscle. It was noted in a few cases that collagenous micronodules could be mistaken for a nerve. The distance between Cancer and nerve was another cause of disagreement. Although the results suggest that the reproducibility of PNI may be greater than that of prostate Cancer Grading, there is still a need for improvement and standardization.
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Prostate Cancer Grading, time to go back to the future.
BJU international, 2020Co-Authors: Lars Egevad, Brett Delahunt, David G. Bostwick, Andrew Evans, Liang Cheng, Troy Gianduzzo, Markus Graefen, Jonas Hugosson, James G. Kench, Katia R. M. LeiteAbstract:In November 2014, the International Society of Urological Pathology (ISUP) convened a consensus meeting in Chicago, USA to consider Grading criteria for prostatic adenocarcinoma [1]. The primary purpose and main outcome of this meeting was a recommendation that not only should the Gleason score of prostate Cancer be reported but that Grading should also incorporate a 5-tier grade based on a grouping of Gleason scores. The outcome of the conference has resulted in widespread confusion as to the Grading nomenclature. This has weighed heavily on the prostate Cancer literature to the extent that the time has now come to question the scientific value of the score grouping.
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Dataset for the reporting of prostate carcinoma in radical prostatectomy specimens: updated recommendations from the International Collaboration on Cancer Reporting
Virchows Archiv, 2019Co-Authors: James G. Kench, Kiril Trpkov, Brett Delahunt, Meagan Judge, Peter A. Humphrey, Glen Kristiansen, Jon Oxley, Krishan Rasiah, Hiroyuki Takahashi, Murali VarmaAbstract:The International Collaboration on Cancer Reporting (ICCR) was formed in 2011 to harmonise the datasets, protocols and checklists for pathological reporting of various Cancers and develop internationally agreed upon, evidence-based datasets. A dataset for prostate Cancer in radical prostatectomy specimens was developed in 2011–2012 as part of a pilot project; however, it required substantial revision following the ISUP Consensus Conference on Gleason Grading in 2014, the publication of the World Health Organisation (WHO) Classification of Tumours of the Urinary System and Male Genital Organs in 2016, and the 8th edition of the Tumour-Node-Metastasis (TNM) staging system in late 2016. This article presents the up-to-date, evidence-based ICCR dataset and associated commentary for reporting prostate Cancer in radical prostatectomy specimens. PubMed and Google search engines were used to review the published literature on the subject, and the dataset was developed in line with the previously published ICCR framework for the development of Cancer datasets. Substantial changes have been incorporated into the second edition of the ICCR prostate Cancer (radical prostatectomy) dataset. These include revisions to prostate Cancer Grading, reporting of intraductal carcinoma of prostate and surgical margins, among others. Up-to-date Cancer datasets underpin structured reporting and facilitate the production of consistent and accurate pathological data for patient care as well as comparisons between different cohorts and populations internationally.
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controversial issues in gleason and international society of urological pathology isup prostate Cancer Grading proposed recommendations for international implementation
Pathology, 2019Co-Authors: John R Srigley, Brett Delahunt, Hemamali Samaratunga, Andrew Evans, Liang Cheng, James G. Kench, Athanase Billis, David Clouston, Bungo Furusato, Katia R. M. LeiteAbstract:The Gleason Grading system has been used for over 50 years to prognosticate and guide the treatment for patients with prostate Cancer. At consensus conferences in 2005 and 2014 under the guidance of the International Society of Urological Pathology (ISUP), the system has undergone major modifications to reflect modern diagnostic and therapeutic practices. The 2014 consensus conference yielded recommendations regarding cribriform, mucinous, glomeruloid and intraductal patterns, the most significant of which was the removal of any cribriform pattern from Gleason grade 3. Furthermore, a Gleason score grouping system was endorsed which consisted of five grades where Gleason score 6 (3+3) was classified as grade 1 which better reflected the mostly indolent behaviour of these tumours. Another issue discussed at the meeting and subsequently endorsed was that in Gleason score 7 cases, the percentage pattern 4 should be recorded. This is especially important in situations where modern active surveillance protocols expand to include men with low volume pattern 4. While major progress was made at the conference, several issues were either not resolved or not discussed at all. Most of these items relate to details of assignment of Gleason score and ISUP grade in specific specimen types and Grading scenarios. This detailed review looks at the 2014 ISUP conference results and subsequent literature from an international perspective and proposes several recommendations. The specific issues addressed are percentage pattern 4 in Gleason score 7 tumours, percentage patterns 4 and 5 or 4/5 in Gleason score 8-10 disease, minor (≤5%) high grade patterns when either 2 or 3 patterns are present, level of reporting (core, specimen, case), dealing with grade diversity among site (highest and composite scores) and reporting scores in radical prostatectomy specimens with multifocal disease. It is recognised that for many of these issues, a strong evidence base does not exist, and further research studies are required. The proposed recommendations mostly reflect consolidated expert opinion and they are classified as established if there was prior agreement by consensus and provisional if there was no previous agreement or if the item was not discussed at prior consensus conferences. For some items there are reporting options that reflect the local requirements and diverse practice models of the international urological pathology community. The proposed recommendations provide a framework for discussion at future consensus meetings.
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Evolution, controversies and the future of prostate Cancer Grading.
Pathology international, 2019Co-Authors: Lars Egevad, Brett Delahunt, John Yaxley, Hemamali SamaratungaAbstract:Histological Grading of prostate Cancer is one of the most important tissue-based parameters for prediction of outcome and treatment response. Gleason Grading remains the foundation of prostate Cancer Grading, but has undergone a series of changes in the past 30 years, often initiated by consensus conference decisions. This review summarizes the most important modifications that were introduced by the 2005 and 2014 International Society of Urological Pathology (ISUP) revisions of Gleason Grading and discusses the impact that these have had on current Grading practices. A considerable inflation in Gleason scores has been observed, especially following the ISUP 2005 revision, and the effects of this are discussed. ISUP 2014 Grading recommendations are described, including the reporting of ISUP grades 1-5. Controversial issues include methods for reporting of grades on needle biopsies, reporting of percent Gleason grades 4/5 and Grading of cribriform and intraductal carcinoma of the prostate. Educational programs developed recently to promote standardization of Grading are described and their results assessed.
Misop Han - One of the best experts on this subject based on the ideXlab platform.
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new prostate Cancer Grading system predicts long term survival following surgery for gleason score 8 10 prostate Cancer
European Urology, 2017Co-Authors: Won Sik Ham, Heather J Chalfin, Zhaoyong Feng, Bruce J Trock, Jonathan I Epstein, Carling Cheung, Elizabeth B Humphreys, Alan W Partin, Misop HanAbstract:Abstract Background The newly proposed five-tiered prostate Cancer Grading system (PCGS) divides Gleason score (GS) 8–10 disease into GS 8 and GS 9–10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes. Objective To assess the significance of distinguishing GS 8 versus 9–10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS. Design, setting, and participants Of 23918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8–10, and 1047 men with RP GS 8–10. Outcome measures and statistical analysis Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9–10. We compared all-cause mortality (ACM) and prostate Cancer–specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event. Results and limitations Compared to men with GS 8, men with GS 9–10 had later RP year and higher pathologic stage. Among men with Bx GS 8–10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1–7) for both overall and Cancer-specific survival. Of men with RP GS 8–10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2–8) and 4 yr (IQR 2–9) for overall and Cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9–10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37–3.30; p p Conclusions Men with GS 9–10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9–10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS. Patient summary The prostate Cancer Grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason score 8–10 disease based on both biopsy and RP Gleason scores. There are significant differences in all-cause mortality and prostate Cancer–specific mortality following surgery between men with Gleason score 8 and those with Gleason score 9–10 disease.
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New Prostate Cancer Grading System Predicts Long-term Survival Following Surgery for Gleason Score 8–10 Prostate Cancer
European urology, 2016Co-Authors: Won Sik Ham, Heather J Chalfin, Zhaoyong Feng, Bruce J Trock, Jonathan I Epstein, Carling Cheung, Elizabeth B Humphreys, Alan W Partin, Misop HanAbstract:Abstract Background The newly proposed five-tiered prostate Cancer Grading system (PCGS) divides Gleason score (GS) 8–10 disease into GS 8 and GS 9–10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes. Objective To assess the significance of distinguishing GS 8 versus 9–10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS. Design, setting, and participants Of 23918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8–10, and 1047 men with RP GS 8–10. Outcome measures and statistical analysis Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9–10. We compared all-cause mortality (ACM) and prostate Cancer–specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event. Results and limitations Compared to men with GS 8, men with GS 9–10 had later RP year and higher pathologic stage. Among men with Bx GS 8–10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1–7) for both overall and Cancer-specific survival. Of men with RP GS 8–10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2–8) and 4 yr (IQR 2–9) for overall and Cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9–10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37–3.30; p p Conclusions Men with GS 9–10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9–10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS. Patient summary The prostate Cancer Grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason score 8–10 disease based on both biopsy and RP Gleason scores. There are significant differences in all-cause mortality and prostate Cancer–specific mortality following surgery between men with Gleason score 8 and those with Gleason score 9–10 disease.
