Scribd
Upload
662 views2 pages

Prostate Acinar Adenocarcinoma Gleason Grading: Often Disqualifies From Active Surveillance

1. The document describes the Gleason grading system for prostate cancer, which assigns grades 1 through 5 based on tumor morphology. Higher grades indicate more poorly differentiated and aggressive cancers. 2. It provides criteria for assigning Gleason scores based on the most and second most common grades seen on biopsy or prostatectomy specimens. 3. Active surveillance criteria from NCCN guidelines are outlined for monitoring low risk prostate cancers initially managed with surveillance rather than immediate treatment.

Uploaded by

Pankaj Dubey
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
662 views2 pages

Prostate Acinar Adenocarcinoma Gleason Grading: Often Disqualifies From Active Surveillance

1. The document describes the Gleason grading system for prostate cancer, which assigns grades 1 through 5 based on tumor morphology. Higher grades indicate more poorly differentiated and aggressive cancers. 2. It provides criteria for assigning Gleason scores based on the most and second most common grades seen on biopsy or prostatectomy specimens. 3. Active surveillance criteria from NCCN guidelines are outlined for monitoring low risk prostate cancers initially managed with surveillance rather than immediate treatment.

Uploaded by

Pankaj Dubey
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Prostate Acinar Adenocarcinoma

Gleason Grading
Circumscribed nodule of closely packed but
separate, uniform, rounded to oval, medium-

1
sized acini

Should not be diagnosed regardless of the type


of specimen, with extremely rare exceptions

Fairly circumscribed, yet at the edge of the


tumor nodule there may be minimal infiltration

2 Glands are more loosely arranged and not quite


as uniform as Gleason pattern 1

Very rarely diagnosed

Well-formed glands (with lumina)

3
Separate, Non-fused

Infiltration

Ill-defined, poorly formed glands


Gland fusion

4
ALL cribriform glands
Hypernephromatoid
Glomerulations (possibly)

Ductal Adenocarcinoma

Often Disqualifies from Active Surveillance

Essentially no glandular differentiation:


• solid sheets

5 • cords
• single cells

Comedocarcinoma with central necrosis


Biopsies:
Gleason Scoring
Most common + Second most common = Score
• No tertiary pattern assigned
• In the setting of high-grade cancer one should ignore lower-grade patterns if they occupy less
than 5% of the area of the tumor. (e.g., 98% pattern 4 and 2% pattern 3 → 4+4=8)
• High-grade tumor of any quantity, as long as it was identified at low to medium magnification
should be included. (e.g., 98% pattern 3 and 2% pattern 4 → 3+4=7)
• On needle biopsies with patterns 3, 4, and 5, both the primary pattern and the highest grade
should be recorded. Consequently, tumors with Gleason score 3 + 4 and a tertiary pattern 5
would be recorded as Gleason score 3 + 5 = 8.
Prostatectomies:
Most common + Second most common = Score, with tertiary pattern if present
• In the setting of high-grade cancer one should ignore lower-grade patterns if they occupy less
than 5% of the area of the tumor.

Grade Groups
Grade Group Gleason Score
1 ≤6
2 3+4=7
3 4+3=7
4 8
5 9-10

Active Surveillance
NCCN Inclusion Criteria:
Absolute (Low risk):
• Gleason Score ≤6
• PSA <10 ng/mL
• Clinical stage <T2a (Tumor involves one-half of one lobe or less)
Especially if (Very low risk):
• Fewer than 3 prostate biopsy cores positive, all ≤50%
• PSA density <0.15 ng/mL/g

NCCN Progression Criteria: (initiates transition to curative therapy)


• Gleason grade 4 or 5 on repeat biopsy
• Prostate cancer found in a greater number of biopsies or greater extent of biopsies

You might also like