Validation of a contemporary prostate cancer grading system using prostate cancer death as outcome

Daniel M. Berney*, Luis Beltran, Gabrielle Fisher, Bernard V. North, David Greenberg, Henrik Møller, Geraldine Soosay, Peter Scardino, Jack Cuzick

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

83 Citations (Scopus)


Background:Gleason scoring (GS) has major deficiencies and a novel system of five grade groups (GS≤6; 3+4; 4+3; 8; ≥9) has been recently agreed and included in the WHO 2016 classification. Although verified in radical prostatectomies using PSA relapse for outcome, it has not been validated using prostate cancer death as an outcome in biopsy series. There is debate whether an 'overall' or 'worst' GS in biopsies series should be used.Methods:Nine hundred and eighty-eight prostate cancer biopsy cases were identified between 1990 and 2003, and treated conservatively. Diagnosis and grade was assigned to each core as well as an overall grade. Follow-up for prostate cancer death was until 31 December 2012. A log-rank test assessed univariable differences between the five grade groups based on overall and worst grade seen, and using univariable and multivariable Cox proportional hazards. Regression was used to quantify differences in outcome.Results:Using both 'worst' and 'overall' GS yielded highly significant results on univariate and multivariate analysis with overall GS slightly but insignificantly outperforming worst GS. There was a strong correlation with the five grade groups and prostate cancer death.Conclusions:This is the largest conservatively treated prostate cancer cohort with long-term follow-up and contemporary assessment of grade. It validates the formation of five grade groups and suggests that the 'worst' grade is a valid prognostic measure.

Original languageEnglish
Pages (from-to)1078-1083
Number of pages6
JournalBritish Journal of Cancer
Issue number10
Publication statusPublished - 10 May 2016

Bibliographical note

Funding Information:
We gratefully acknowledge support from Cancer Research UK, ORCHID, a SPORE grant from the US National Cancer Institute (P50CA09629), the David H. Koch Fund and Myriad Genetics. We thank investigators and staff in the cancer registries and participating hospitals for their support.

Publisher Copyright:
© 2016 Cancer Research UK.


  • Gleason grade
  • Gleason score
  • prostate


Dive into the research topics of 'Validation of a contemporary prostate cancer grading system using prostate cancer death as outcome'. Together they form a unique fingerprint.

Cite this