Helpap Burkhard, Egevad Lars
Department of Pathology, Center of Uropathology, General Hospital Hegau-Bodensee-Klinikum Singen, Academic Hospital of the University of Freiburg, Germany.
Histol Histopathol. 2009 May;24(5):661-6. doi: 10.14670/HH-24.661.
At an ISUP (International Society of Urological Pathology) consensus conference in 2005 in San Antonio, Texas, the old Gleason grading system for prostatic carcinoma from 1966 underwent its first major revision. With this modified Grading system a shift of the most frequent Gleason scores from 6 to 7a (3+4) in biopsy specimens and an increased degree of agreement between specimens of biopsies and radical prostatectomies with carcinoma of the prostate could be demonstrated. After modified grading of GS 3+4=7a tumours 95% were stage pT2, while 79% of GS 4+3=7b tumours were stage pT3-4. In cases with PSA <10 ng/ml and tumour extent <20% the most frequent Gleason scores were 6 and 7a. Cases with serum PSA >10 ng/ml or tumour extent >20% had higher scores (7b or higher). Cancers with tumour infiltration of <1mm in one of 12 cores and PSA <10 ng/ml were mainly low grade (Gleason scores 6 and 7a) and may correspond to so called insignificant carcinoma of the prostate.
With the modified Gleason system, grade, stage, tumour extent and serum PSA show good correlations and characterize the difference between low and high grade malignancy of prostate carcinoma.
在2005年于得克萨斯州圣安东尼奥举行的国际泌尿病理学会（ISUP）共识会议上，1966年的旧前列腺癌Gleason分级系统首次进行了重大修订。采用这种改良的分级系统，可以证明活检标本中最常见的Gleason评分从6分转变为7a（3 + 4）分，并且前列腺癌活检标本与根治性前列腺切除术标本之间的一致性程度有所提高。对GS 3 + 4 = 7a肿瘤进行改良分级后，95%为pT2期，而GS 4 + 3 = 7b肿瘤的79%为pT3 - 4期。在PSA < 10 ng/ml且肿瘤范围 < 20%的病例中，最常见的Gleason评分为6分和7a分。血清PSA > 10 ng/ml或肿瘤范围 > 20%的病例评分更高（7b或更高）。在12个核心标本中有1个肿瘤浸润 < 1mm且PSA < 10 ng/ml的癌症主要为低级别（Gleason评分6分和7a分），可能对应于所谓的前列腺微小癌。
采用改良的Gleason系统，分级、分期、肿瘤范围和血清PSA显示出良好的相关性，并可区分前列腺癌低级别和高级别恶性肿瘤之间的差异。
