Moving Beyond Gleason Scoring

Brian J. Miles, Michael Ittmann, Thomas Wheeler, Mohammad Sayeeduddin, Antonio Cubilla, David Rowley, Ping Bu, Yi Ding, Yan Gao, Min Jae Lee, Gustavo E. Ayala

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


CONTEXT.—: The combination of grading and staging is the basis of current standard of care for prediction for most cancers. D. F. Gleason created the current prostate cancer (PCa) grading system. This system has been modified several times. Molecular data have been added. Currently, all grading systems are cancer-cell based. OBJECTIVE.—: To review the literature available on host response measures as reactive stroma grading and stromogenic carcinoma, and their predictive ability for PCa biochemical recurrence and PCa-specific death. DATA SOURCES.—: Our own experience has shown that reactive stroma grading and the subsequently binarized system (stromogenic carcinoma) can independently predict biochemical recurrence and/or PCa-specific death, particularly in patients with a Gleason score of 6 or 7. Stromogenic carcinoma has been validated by 4 other independent groups in at least 3 continents. CONCLUSIONS.—: Broders grading and Dukes staging have been combined to form the most powerful prognostic tools in standard of care. The time has come for us to incorporate measures of host response (stromogenic carcinoma) into the arsenal of elements we use to predict cancer survival, without abandoning what we know works. These data also suggest that our current definition of PCa might need some revision.

Original languageEnglish (US)
Pages (from-to)565-570
Number of pages6
JournalArchives of pathology & laboratory medicine
Issue number5
StatePublished - May 1 2019

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology


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