Article Text

Changes in Gleason Scores for Prostate Cancer
  1. Jorge Ramos, DO*,
  2. Edward Uchio, MD†‡,
  3. Mihaela Aslan, PhD,
  4. John Concato, MD, MS, MPH*§∥
  1. From the Departments of *Medicine, and †Surgery (Urology), Yale University School of Medicine, New Haven, CT; ‡Surgical Service (Urology), §Clinical Epidemiology Research Center, and ∥Medical Service, VA Connecticut Healthcare System, West Haven, CT.
  1. Received October 13, 2009, and in revised form December 11, 2009.
  2. Accepted for publication January 5, 2010.
  3. Reprints: John Concato, MD, MS, MPH, VA Connecticut Healthcare System, Clinical Epidemiology Research Center (151B), 950 Campbell Ave, West Haven, CT 06516. E-mail: john.concato{at}

What Should We Expect From a Measurement?


Background Men diagnosed with prostate cancer receive therapy based on various clinical characteristics, including the Gleason score, a measurement (range, 2-10) describing a tumor's histological appearance. An upward shift has occurred in the distribution of Gleason scores during the past decade; this change was influenced by reports suggesting that lower scores (range, 2-4) should not be assigned to biopsy specimens.

Methods We (1) compared Gleason scores from 1994-1995 and 2004-2005 at the same institution, (2) reviewed representative articles examining changes in Gleason scores during the last 2 decades, and (3) assessed the implications of a change in histological measurements.

Results Among men diagnosed with prostate cancer at VA Connecticut, Gleason scores 2 to 4 were reported for 11.4% (19/167) of specimens in 1994-1995 but only 0.4% (1/260) of specimens in 2004-2005; this difference persisted after adjusting for age, clinical stage, and prostate-specific antigen (P < 0.001). Similar results were evident in previous publications on this topic. A change in criteria for a clinical measurement may have unintended consequences, including problems of inconsistency across "time" and "place."

Conclusions Recent shifts in Gleason scores have led to fewer patients being diagnosed with low-grade prostate cancer; this change can have adverse impacts in clinical care and research.

Key Words
  • prostate cancer
  • histology
  • Gleason score
  • measurements
  • patient-oriented research
  • clinical epidemiology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.