Letters to the Editor Open access

Should pathologists and clinicians continue to consider Grade Group 1 (Gleason score ≤6) prostate cancer as a true carcinoma? Let’s hear from patient advocates

Authors

Published
10 June 2025
Section
Letters to the Editor
DOI
10.4081/aiua.2025.13925

Abstract

To the Editor,

The current grading system for prostate cancer (PCA) includes 5 Grade Groups (GG): GG1 (Gleason score ≤ 6); GG2 (Gleason score 3+4); GG3 (Gleason score 4+3); GG4 (Gleason score 4+4; or 3+5; or 5+3); GG5 (Gleason scores 4+5/5+4/5+5). The GG system is one of the most important predictors of outcome in PCA patients...

Keywords

References

  1. Montironi R, Cheng L, Cimadamore A, et al. Narrative review of prostate cancer grading systems: will the Gleason scores be replaced by the Grade Groups? Transl Androl Urol. 2021; 10:1530-1540. DOI: https://doi.org/10.21037/tau-20-853
  2. Mazzucchelli R, Barbisan F, Scarpelli M, et al. Is incidentally detected prostate cancer in patients undergoing radical cystoprostatectomy clinically significant? Am J Clin Pathol. 2009; 131:279-283. DOI: https://doi.org/10.1309/AJCP4OCYZBAN9TJU
  3. Shah RB, Paner GP, Cheng L, et al. Genitourinary Pathology Society and International Society of Urological Pathology white paper on defining indolent prostate cancer: call for a multidisciplinary approach. Eur Urol. 2025:S0302-2838(25)00150-2. Online ahead of print.
  4. Epstein JI, Kibel AS. Renaming Gleason score 6 prostate to noncancer: a flawed idea scientifically and for patient care. J Clin Oncol. 2022;40:3106-3109. DOI: https://doi.org/10.1200/JCO.22.00926
  5. Ross HM, Kryvenko ON, Cowan JE, et al. Do adenocarcinomas of the prostate with Gleason score (GS) =6 have the potential to metastasize to lymph nodes? Am J Surg Pathol. 2012; 36:1346-1352. DOI: https://doi.org/10.1097/PAS.0b013e3182556dcd
  6. Anderson BB, Oberlin DT, Razmaria AA, et al. Extraprostatic extension is extremely rare for contemporary gleason score 6 prostate cancer. Eur Urol. 2017; 72:455-460. DOI: https://doi.org/10.1016/j.eururo.2016.11.028
  7. Lokman U, Erickson AM, Vasarainen H, et al. PTEN loss but not ERG expression in diagnostic biopsies is associated with increased risk of progression and adverse surgical findings in men with prostate cancer on active surveillance. Eur Urol Focus. 2018; 4:867-873. DOI: https://doi.org/10.1016/j.euf.2017.03.004
  8. Carter HB, Helfand B, Mamawala M, et al. Germline mutations in ATM and BRCA1/2 are associated with grade reclassification in men on active surveillance for prostate cancer. Eur Urol. 2019; 75:743-749. DOI: https://doi.org/10.1016/j.eururo.2018.09.021
  9. Zhou M, Amin A, Fine SW, et al. Should grade group 1 prostate cancer be reclassified as "non-cancer"? A pathology community perspective. Urol Oncol. 2023; 41:62-64. DOI: https://doi.org/10.1016/j.urolonc.2022.09.028
  10. Saoud R, Woranisarakul V, Paner GP, et al. Physician perception of grade group 1 prostate cancer. Eur Urol Focus. 2023;9:966-973. DOI: https://doi.org/10.1016/j.euf.2023.04.002

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2025 the Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.