gleason scoring system 2017 - moffitt · gleason score 2-4 is not made on needle biopsies and...
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Gleason Scoring System 2017 JASREMAN DHILLON, MD
ASSOCIATE PROFESSOR,
DEPARTMENT OF ANATOMIC PATHOLOGY,
MOFFITT CANCER CENTER,
TAMPA, FLORIDA
Learners Objectives
u Latest changes per ISUP 2014 that impact Gleason patterns
u Changes in the reporting of PA with inclusion of Grade Groups and % of Grade 4 component in GS 7
u When to report and when not to report GS in post therapy biopsies
u Concepts about IDC-P
Gleason Score 2-4 is Not Made on Needle Biopsies and Prostatectomies
u 1) Poor reproducibility among experts for lower grade tumors.
u 2) Correlation with the prostatectomy score for Gleason 2-4 tumors is poor and up to 50% of the corresponding prostatectomies may have extraprostatic extension.
u Totally embedded RPs from 1975-2010 reported as GS <6 were identified from the combined RP databases of four large academic centers. Participating institutions were The Johns Hopkins Hospital, Henry Ford Hospital, University of California San Francisco (UCSF), and Baylor College of Medicine.
u 19 cases, mostly from the 1990s, diagnosed as GS<6 with a positive LN
Conclusions From Study
u Of over 14,000 totally embedded radical prostatectomies from multiple institutions, there was not a single case of a GS ≤6 tumor with LN metastases.
u GS ≤6 tumors do not appear to metastasize to LNs.
u Gleason patterns 4 or 5, as defined by the current ISUP system, is required for metastatic disease.
u Cannot rely on grading prior to 2005 as accurate.
After ISUP 2005 there were multiple studies showing small foci of smoothly circumscribed cribriform prostate cancers are associated with an adverse prognosis
Epstein et al
Gleason Grading System
u Gleason’s original data u GS 2-5 comprised 28% u GP 4 (GS 7, 8, 9) comprised 12%
u Danneman et al u GS 2-5 comprised 27% in 1998 u GS 2-5 comprised 1% in 2011 u GS 7 comprised 38% in 2011
u Grade scores 2-5 have disappeared from clinical practice
Foamy Gland Cancer
Pseudohyperplastic Cancer
Colloid Carcinoma
Signet Ring Cell-Like Adenocarcinoma
Ductal Adenocarcinoma
Are graded by same rules as the usual prostate cancer
Variants of Prostate Cancer
Ductal Adenocarcinoma
u Ductal adenocarcinomas
is graded as Gleason score 4+4=8
u Ductal adenocarcinoma
with necrosis grades as Gleason pattern 5.
u PIN-Like ductal
adenocarcinoma is graded as 3+3=6 as it has excellent prognosis
Small Cell Carcinoma
Small cell carcinoma of the prostate is not assigned a Gleason score since it is unique histological, immunohistochemical, and clinical features.
Post-Therapy Prostate Cancer
If histologically, usual prostate cancer is seen following hormone therapy, radiation therapy, cryotherapy or HIFU and it resembles non-treated cancer – “Cancer without significant treatment affect” and a Gleason score is assigned.
Histologically cancer is seen,
and it shows treatment effect – no Gleason score is assigned.
Reporting Percent Pattern 4 u 1.Ac&vesurveillanceinpa&entswith7(3+4)
u Age
u co-morbidity
u extentofcancer
u MRIfindings
u pa&entdesire
u CanbecandidatesforASifthe%ofpaJern4islimited
u 2.Borderlinecasesof7(3+4)or7(4+3)
u Benefitthetrea&ngphysicianindecidingtheappropriatetherapyforthepa&entincombina&onwithotherclinicalparameterssuchasPSAlevels,%oftumorpresent,numberofcoreposi&ve,MRIfindings
GradingGroups
• Fiveprognos&callydis&nctGradeGroupsbasedonthemodifiedGleasonscoregroups
– GradeGroup1=Gleasonscore≤6– GradeGroup2=Gleasonscore3+4=7– GradeGroup3=Gleasonscore4+3=7– GradeGroup4=Gleasonscore8– GradeGroup5=Gleasonscores9and10
Intraductal Carcinoma of the Prostate (IDC-P)
u IDC-Pisamalignantlesionu Expansileprolifera&onofmalignantprosta&cepithelialcellswithinprosta&cductsandacini
u significantarchitecturalandcytologicalatypiau IDC-Passociatedwith
u largetumorvolumeu advanceddiseasestage-extraprosta&cextension,seminalvesicleinvasion,andpelviclymphnodemetastases
u highGleasonscoreu increasedriskofrecurrence
IDC-P in Prostate Biopsies
u IDC-P,whenpresentinacoreneedlebiopsy,requiresaprompt
re-biopsyordefini&vetreatment
u IDC-Phasbeenreportedinabout2.8%ofbiopsies
u ThepresenceofisolatedIDC-Pwithoutaccompanyinginvasiveadenocarcinomaisextremelyrare,occurringin<0.3%ofcoreneedlebiopsies
u IDC-Pinprostatebiopsies
u Earlybiochemicalfailure
u metasta&cdiseasefollowingradia&ontreatmentinpa&entswithintermediateorhigh-riskprostatecancer.
IDC-P in Radical Prostatectomies
u IDC-Pinradicalprostatectomyspecimensu increaseintheincidenceofbiochemicalrecurrence
u 61-84%ofIDC-PcasesshowlossofPTEN
u TMPRSS2:ERGgenefusion>2/3rdofcasesofIDC-P
ERG IHC
References
u Hillary M. Ross, Oleksandr N. Kryvenko, Janet E. Cowan, Jeffry P. Simko, Thomas M. Wheeler and Jonathan I. Epstein. Do adenocarcinomas of the prostate with gleason score (gs) ≤6 have the potential to metastasize to lymph nodes? Am J Surg Pathol. 2012 Sep; 36(9): 1346–1352.
u Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA; Grading Committee. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016 Feb;40(2):244-52.
u Mukul K. Divatia and Jae Y. Ro. Intraductal Carcinoma of the Prostate Gland: Recent Advances. Yonsei Med J. 2016 Sep 1; 57(5): 1054–1062.
u Thomas M Schneider and Adeboye O Osunkoya. ERG expression in intraductal carcinoma of the prostate: comparison with adjacent invasive prostatic adenocarcinoma. Modern Pathology (2014) 27, 1174–1178.
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