Evaluation of histological grading (Gleason) in carcinoma of the prostate: Adverse influence of highest grade

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Abstract
The value of the Gleason system of histological grading in carcinoma of the prostate is a subject of considerable controversy. The value of this system is demonstrated in a group of 488 patients treated radically with radiation therapy.Analysis, utilizing the Gleason system in these patients, indicates that the worst histological grade identified is most important in determining the prognosis. Since nearly 18%of our patients have more than two grades identified, simple identification of primary and secondary grades, ie, the two predominating grades, is inadequate and may underestimate the aggressiveness of the tumor. This finding has implications in the analysis of the results of treatment and in determining the method of treatment in individual patients.