The impact of the 2005 International Society of Urological Pathology (ISUP) consensus on Gleason grading in contemporary practice

AIMS: To investigate the impact of the 2005 International Society of Urological Pathology (ISUP) Gleason grading consensus in contemporary practice. METHODS AND RESULTS: The Gleason scores (GS) were compared in two consecutive patient cohorts with matched biopsies and prostatectomies: (i) 908 patients evaluated before the ISUP consensus (July 2000-June 2004) and (ii) 423 patients evaluated after the ISUP consensus (October 2005-June 2007). All biopsies and prostatectomies were performed and scored in one institution and were sampled and processed identically. There was a higher percentage of biopsy and prostatectomy specimens with GS > or = 7 after the ISUP consensus (GS > or = 7 on biopsy in 32% before ISUP versus 46% after ISUP; GS > or = 7 on prostatectomy in 53% before ISUP versus 68% after ISUP; P < 0.001). No significant difference in the complete and + or -1 unit Gleason agreement was found before and after the ISUP consensus. There was a trend towards better complete agreement for GS > or = 7 after the ISUP consensus. CONCLUSIONS: There was a shift towards higher GS on biopsy and prostatectomy in our practice after the ISUP consensus, although - there was no significant impact on the biopsy-prostatectomy Gleason agreement. The significance of this shift for patient management and prognosis is uncertain.