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

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Abstract
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 ≥ 7 after the ISUP consensus (GS ≥ 7 on biopsy in 32% before ISUP versus 46% after ISUP; GS ≥ 7 on prostatectomy in 53% before ISUP versus 68% after ISUP; P < 0.001). No significant difference in the complete and ±1 unit Gleason agreement was found before and after the ISUP consensus. There was a trend towards better complete agreement for GS ≥ 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.

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