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Borderline Gleason scores: communication is the key
  1. Murali Varma1,
  2. Brett Delahunt2,
  3. Theodorus H van der Kwast3,
  4. Sean R Williamson4,
  5. Daniel M Berney5
  1. 1 Cellular Pathology, University Hospital of Wales, Cardiff, UK
  2. 2 Pathology and Molecular Medicine, Wellington School Medicine, Wellington, New Zealand
  3. 3 Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
  4. 4 Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5 Molecular Oncology, Queen Mary University of London, London, UK
  1. Correspondence to Dr Murali Varma, Cellular Pathology, University Hospital of Wales, Cardiff CF14 4XW, UK; wptmv{at}

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The biopsy Gleason score (GS) is a critical component of patient management having been demonstrated to be an excellent predictor of patient outcome.1 2 While the application of Gleason grading is generally straightforward, grading is subject to significant interobserver variation3 and divergent opinions may confuse clinicians and patients.

Interobserver variation may be due to the application of different grading rules or more commonly different interpretations of borderline morphological appearances. The former is avoidable and multiple consensus conferences have sought to define uniform criteria for grading prostate cancer.4–7 However, the latter is inevitable in a morphological continuum. We seek to explain why precise grading becomes less important in this scenario, if the findings are effectively communicated by the pathologist and correctly interpreted by the clinician.

Gleason grades commonly represent a morphological continuum from well-formed glands (pattern 3) to increasingly smaller-sized and poorly formed glandular proliferations (pattern 4) and finally to almost no glandular differentiation (pattern 5). Thus, GS is often a continuous variable with arbitrary cut-offs. This is analogous to serum Prostate Specific Antigen (PSA) where arbitrary cut-offs are used to categorise patients into risk groups. However, unlike serum PSA, grade is reported as …

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  • Handling editor Runjan Chetty.

  • Contributors The first draft was written by MV. All authors contributed to subsequent revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.