Open AccessMoving Beyond Gleason Scoring
Author(s) -
Brian J. Miles,
Michael Ittmann,
Thomas M. Wheeler,
Mohammad Sayeeduddin,
Antonio L. Cubilla,
David R. Rowley,
Ping Bu,
Yi Ding,
Yan Gao,
Minjae Lee,
Gustavo Ayala
Publication year - 2019
Publication title -
archives of pathology and laboratory medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.79
H-Index - 117
eISSN - 1543-2165
pISSN - 0003-9985
DOI - 10.5858/arpa.2018-0242-ra
Subject(s) - grading (engineering) , medicine , stroma , carcinoma , prostate cancer , oncology , pathology , cancer , biology , immunohistochemistry , ecology
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.