ABSTRACT

Prostate carcinoma has changed dramatically since late 1960s when the Gleason grading system was described in the 1960s. There was no screening for prostate carcinoma other than by digital rectal examination because serum prostate-spesific antigen had not been discovered. The Gleason grading system also predated the use of immunohistochemistry. Further issues relating to radical prostatecomy specimens, such as the grading of multiple nodules within the same prostate as well as variants of prostate carcinoma or dealing with tertiary patterns were not addressed within the original Gleason system. As a result of these changes in prostate cancer, the system was updated at a 2005 consensus conference of international experts in urological pathology, supported by the International Society of Urological Pathology. It is remarkable that nearly 40 years after its inception, the Gleason system remains one of the most powerful prognostic factors in prostate cancer. This system has remain timely by minor adaptations to accommodate the changing practice of medicine.