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Gleason grade grouping of prostate cancer is of prognostic value in Asian men
  1. Joe Yeong1,2,
  2. Rehena Sultana3,
  3. Jonathan Teo4,
  4. Hong Hong Huang4,
  5. John Yuen4,
  6. Puay Hoon Tan5,
  7. Li Yan Khor1
  1. 1 Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
  2. 2 Singapore Immunology Network (SIgN), Agency of Science, Technology and Research (A*STAR), Singapore, Singapore
  3. 3 DUKE-NUS Medical School, Center For Quantitative Medicine, Singapore, Singapore
  4. 4 Department of Urology, Singapore General Hospital, Singapore, Singapore
  5. 5 Division of Pathology, Singapore General Hospital, Singapore, Singapore
  1. Correspondence to Dr Li Yan Khor, Department of Anatomic Pathology, Division of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 10, Diagnostics Tower Singapore 169856, Singapore;{at}


Aim The International Society of Urological Pathology made recommendations for the use of Grade Groups (GG) originally described by Epstein and colleagues over Gleason score (GS) alone in 2014, which was subsequently adopted by the WHO classification in 2016. The majority of studies validating this revision have been in Caucasian populations. We therefore asked whether the new GG system was retrospectively associated with biochemical disease-free survival in a mixed-ethnicity cohort of Asian men.

Methods A total of 680 radical prostatectomies (RPs) from 2005 to 2014 were included. GS from initial biopsy and RP were compared and used to allocate cases to GG, defined as: 1 (GS≤6); 2 (GS 3+4=7); 3 (GS 4+3=7); 4 (GS 4+4=8/5+3=8/3+5=8) and 5 (GS 9–10). Biochemical recurrence was defined as two consecutive post-RP prostate-specific antigen (PSA) levels of >0.2 ng/mL after post-RP PSA reaching the nadir of <0.1 ng/mL.

Results Our data showed that Kaplan–Meier analysis revealed significant differences in biochemical recurrence within Gleason GG based on either biopsy or prostatectomy scoring. Multivariate analysis further confirmed that a higher GG was significantly associated with risk of biochemical recurrence. This GG system had a higher prognostic discrimination for both initial biopsy and RP than GS.

Conclusions Our study validates the use of the revised and updated GG system in a mixed-ethnicity population of Asian men. Higher GG was significantly associated with increased risk of biochemical recurrence. We therefore recommend its use to inform clinical management for patients with prostate cancer.


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  • Handling editor Cheok Soon Lee

  • Contributors The study was designed and directed by PHT and LYK and coordinated by JY. JY, JT and HHH acquired the data. The analysis was done by RS, HHH and JT; JT and JY provided advice and guidance from a clinical urology perspective. JY and LYK drafted the manuscript, which was commented on and revised by all authors.

  • Competing interests None declared.

  • Ethics approval SingHealth Centralised Institutional Review Board, Singapore.

  • Provenance and peer review Not commissioned; externally peer reviewed.