New System for Grading Prostate Cancers

A new and simpler grading system for prostate cancers will be introduced to Australia soon. 

The new system has been produced through research carried out by the International Society of Urological Pathology (ISUP) and has been endorsed by the World Health Organization. It will gradually replace the Gleason scoring system which has been in use since the 1960s.

The new system has five grades as does the current Gleason system but it is less complex and confusing for non-specialists in this area and for patients. Prostate cancers often have two or more patterns of tumour behaviour spread throughout the tumour. The Gleason system dealt with this by giving two scores between 1 and 5 for the major patterns and adding them together to give an overall score between 2 and 10. However in practice the lowest Gleason score reported would be 6 and tumours with scores less than or equal to 6 have a good prognosis. This can be very confusing for a layperson who often reasonably assumes that a score of 6 on a scale of 1 to 10 must reflect quite a nasty tumour. The new ISUP grading only gives one score on a scale 1 to 5 and a Gleason score of 6 or less is equivalent to an ISUP score of 1.

The new system was developed after assessing outcomes in more than 20,000 prostate cancer cases treated with radical prostatectomy and more than 5,000 cases treated by radiation therapy. Recent studies by Australian and New Zealand pathologists have confirmed the new ISUP grading system is more accurate than the Gleason system for predicting the spread of disease and death from prostate cancer in affected men. 

Further Reading
Financial Review article
Prostate Cancer Infolink
Johns Hopkins Pathology newsletter (pdf)



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