Indian Journal of Urology Users online:807  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
LETTER TO EDITOR
Year : 2010  |  Volume : 26  |  Issue : 3  |  Page : 462-463
 

Perspectives on the upgradation of Gleason score after radical prostatectomy: Why our uropathologists need to remain abreast with current concepts


Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA

Date of Web Publication1-Oct-2010

Correspondence Address:
Gagan Gautam
Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.70599

Rights and Permissions

 

How to cite this article:
Gautam G. Perspectives on the upgradation of Gleason score after radical prostatectomy: Why our uropathologists need to remain abreast with current concepts. Indian J Urol 2010;26:462-3

How to cite this URL:
Gautam G. Perspectives on the upgradation of Gleason score after radical prostatectomy: Why our uropathologists need to remain abreast with current concepts. Indian J Urol [serial online] 2010 [cited 2019 Sep 15];26:462-3. Available from: http://www.indianjurol.com/text.asp?2010/26/3/462/70599


Dear Editor,

I read with interest the manuscript by Nayyar et al. on the upgradation of Gleason score in radical prostatectomy specimens in relation to the tissue obtained from preoperative needle core biopsies (NCB). [1] According to this well-designed study, 177 patients undergoing radical prostatectomy from 2002 to 2008 had their final Gleason score upgraded from 5.51 ± 1.52 (range 2-9) to 6.2 ± 1.42 (range 2-9) after radical prostatectomy. The authors correctly concluded that this unreliability of preoperative assessment casts a doubt on our ability to offer surveillance protocols to patients with low Gleason scores on preoperative biopsy and may render clinical comparisons between various treatment modalities difficult.

In my view, however, this study also highlights the need to have dedicated uropathologists coordinating with urology teams to administer the best possible diagnostic care to the patients. It has been well established since a while now that a Gleason score of 2-4 should never be diagnosed on NCB with recent suggestions that even a Gleason score of 5 is becoming out of bounds for pathologists interpreting these specimens. These suggestions, which were first espoused by Epstein in 2000, became established in the 2005 consensus conference of the International Society of Urological Pathology (ISUP). The reasons for these conclusions include the following: poor reproducibility even among experts, upgradation of almost all cases after prostatectomy, inability to assess the edge of the lesion, and propagation of a misconception that the urologist may be dealing with an "indolent" tumor. In the year 2001, only 2.4% of all pathologists surveyed, were diagnosing Gleason score 2-4 on NCB. Accordingly, the proportion of biopsies reported as Gleason 2-4 also decreased from 2.7% to 0% after this conference. [2]

Well, apparently not.

This study is another case in point that we as urologists and urooncologists need the support of our pathology colleagues, who in turn owe it to our patients to stay abreast with the latest in uropathologic literature and update their diagnostic services in line with the ever-changing standard of care.

 
   References Top

1.Nayyar R, Singh P, Gupta NP, Hemal AK, Dogra PN, Seth A, et al. Upgrading of Gleason score on radical prostatectomy specimen compared to the pre-operative needle core biopsy: An Indian experience. Indian J Urol 2010;26:56-9.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Epstein JI. An update of the Gleason grading system. J Urol 2010;183:433-40.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  



This article has been cited by
1 Authorsę reply
Nayyar, R., Singh, P., Gupta, N.P., Hemal, A.K., Dogra, P.N., Seth, A., Kumar, R.
Indian Journal of Urology. 2010; 26(3): 463
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

 
   Search
 
   Next article
   Previous article 
   Table of Contents
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (178 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed1604    
    Printed69    
    Emailed0    
    PDF Downloaded38    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

HEALTHWARE INDIA