Gleason grading of prostate cancer

Prostate cancer is one of the most common malignant tumors in Europe and America. It is more common in the elderly and ranks second in the mortality rate of male tumors in the United States. Although the incidence of prostate cancer is relatively low in my country, it is increasing year by year with the increase in life expectancy and changes in dietary structure. It is poorly differentiated, highly malignant, and has a poor prognosis. Therefore, timely diagnosis of prostate cancer is crucial for treatment and prognosis. The grading of prostate adenocarcinoma is an important topic in prostate pathology.

Gleason Grading of Prostate Cancer

1. Characteristics of the Gleason grading system:

(1) Only routine sectioning is used for judgment, without the need for special staining and immunohistochemistry.

(2) The determining factor of Gleason grade is the tissue structure of the tumor; at some levels, cell morphology has reference value, but nuclear morphology is not an indicator of grade.

(3) Based on the tumor tissue structure, it is divided into five types, or grades. Types 3, 4, and 5 have subtypes, namely 3a, 3b, 3c, 4a, 4b, 5a, and 5b, which are used to describe the characteristic morphological structure to facilitate identification by pathologists.

(4) Score = major structural type (level) + minor structural type (level), ranging from 2 to 10, with the lowest being 1+1=2 and the highest being 5+5=10.

(5) From the perspective of treatment and prognosis, it is currently believed that the scores can be divided into four groups: 2-4, 5-6, 7, and 8-10. However, pathologists should try to give accurate scores instead of simply classifying them into a certain group.