Prostate cancer

Gleason score[116]Gleason DF, Mellinger GT, Veterans Administration Cooperative Urological Research Group. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. 1974. J Urol. 2002 Feb;167(2 Pt 2):953-8. http://www.ncbi.nlm.nih.gov/pubmed/11905924?tool=bestpractice.com

The Gleason score is used to grade prostate tumours obtained from biopsy. A biopsy-positive specimen is given a score from 1-5 based on the degree of architectural differentiation of the tumour.

The Gleason score is obtained by assigning a primary grade to the predominant grade present and a secondary grade to the second most prevalent grade; for example, a tumour with grade 3 and grade 2 cells equates to a Gleason score of 5. Gleason scores under 6 are rarely recorded.

• Low-grade tumour: Gleason score ≤6

• Intermediate-grade tumour: Gleason score 7

• High-grade tumour: Gleason score 8-10[Figure caption and citation for the preceding image starts]: Gleason score is based on the degree of architectural differentiation of the prostate tumourHarnden et al. Lancet Oncol. 2007 May;8(5):411-9; used with permission [Citation ends].

International Society of Urologic Pathologists (ISUP) grading system[117]Epstein JI, Zelefsky MJ, Sjoberg DD, et al. A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol. 2016 Mar;69(3):428-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002992 http://www.ncbi.nlm.nih.gov/pubmed/26166626?tool=bestpractice.com [118]Epstein JI, Egevad L, Amin MB, et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016 Feb;40(2):244-52. http://www.ncbi.nlm.nih.gov/pubmed/26492179?tool=bestpractice.com

The ISUP grading system stratifies prostate cancer tumours into the following Grade Groups based on the Gleason score:

• Grade Group 1 corresponds to Gleason score ≤6

• Grade Group 2 corresponds to Gleason score 7 (3+4)

• Grade Group 3 corresponds to Gleason score 7 (4+3)

• Grade Group 4: corresponds to Gleason score 8

• Grade Group 5: corresponds to Gleason score 9 or 10.

The American Urological Association (AUA) symptom index[119]Lehrer S, Stone NN, Droller MJ, et al. Association between American Urologic Association (AUA) urinary symptom score and disease stage in men with localized prostate cancer. Urol Oncol. 2002 Mar-Apr;7(2):73-6. http://www.ncbi.nlm.nih.gov/pubmed/12474526?tool=bestpractice.com

This is used as a symptom scoring instrument in the initial assessment of patients.

It is a self-administered series of seven questions that objectively quantifies urinary symptoms. When the AUA system is used, symptoms should be classified as:

• Mild (0-7)

• Moderate (8-19)

• Severe (20-35).

This tool can be used as a factor to guide treatment selection and as a benchmark for follow-up after treatment.[120]American Urological Association. Benign prostatic hyperplasia: surgical management of benign prostatic hyperplasia/lower urinary tract symptoms (2018, amended 2019, 2020). 2020 [interent publication]. https://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(bph)-guideline [ Prostatism Symptom Score Opens in new window ]

International Index of Erectile Function (IIEF)[121]Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997 Jun;49(6):822-30. http://www.ncbi.nlm.nih.gov/pubmed/9187685?tool=bestpractice.com

This is used to diagnose the presence and severity of erectile dysfunction.

It is a self-administered questionnaire that comprises 15 questions assessing five domains of male sexual function: erectile function; orgasmic function; sexual desire; intercourse satisfaction; and overall satisfaction. A score of 0-5 is awarded to each question.

A shortened version of IIEF that comprises five questions (IIEF-5) has been developed and validated.[122]Rosen RC, Cappelleri JC, Smith MD, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999 Dec;11(6):319-26. http://www.ncbi.nlm.nih.gov/pubmed/10637462?tool=bestpractice.com  The five questions focus on erectile function and intercourse satisfaction.

Prostate imaging reporting and data system (PI-RADS) score[123]American College of Radiology. Prostate imaging reporting and data system (PI-RADS), v2.1. 2015 [internet publication]. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/PI-RADS

PI-RADS is a standardised system for performing and interpreting multiparametric magnetic resonance imaging (MRI) scans of the prostate. The PI-RADS system reports the likelihood of clinically significant prostate cancer using the following 5-point score (based a combination of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI sequences):

• PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)

• PI-RADS 2: low (clinically significant cancer is unlikely to be present)

• PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)

• PI-RADS 4: high (clinically significant cancer is likely to be present)

• PI-RADS 5: very high (clinically significant cancer is highly likely to be present).