Gleason Grading

The literature can be confusing about differences in the grading based on whether it’s a radical prostatectomy or TRUS biopsy and whether to go with the most common or the highest grade and the use of a tertiary grade.

This appears to be the current approach where I work:

  1. Grading for transrectal ultrasound guided biopsies and radical prostatectomies are the same
  2. The most prevalent and second most prevalent grade are added up (eg: 3+4, 4+3 however there does not appear to be a clinical difference in how these are managed)
  3. The tumour needs to show at least 5% of a grade of tumour to for it to be included in the grading including the tertiary grade
  4. The tertiary grade should be used only rarely. When all 3 grades are present. Then the most prevalent and the highest grade is used with the remaining going into the tertiary. (eg: 3+5=8 with tertiary 4 when all 3 present equally in a core bx)
  5. More likely to have a tertiary grade in a prostatectomy as you see much more prostatic tissue.
  6. Grade 3 well formed glands you can draw around, Grade 4 when cribriform or fused glands, Grade 5 when single glands, solid areas or glands associated with comedo type necrosis


RCPath dataset for reporting prostatic carcinoma.

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