The new Epstein gleason score classification significantly reduces upgrading in prostate cancer patients

Cosimo De Nunzio, Antonio Luigi Pastore, Riccardo Lombardo, Giuseppe Simone, Costantino Leonardo, Riccardo Mastroianni, Devis Collura, Giovanni Muto, Michele Gallucci, Antonio Carbone, Andrea Fuschi, Lorenzo Dutti, John H. Witt, Carlo De Dominicis, Andrea Tubaro

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the differences between the old and the new Gleason score classification systems in upgrading and downgrading rates. Materials and methods: Between 2012 and 2015, we identified 9703 patients treated with retropubic radical prostatectomy (RP) in four tertiary centers. Biopsy specimens as well as radical prostatectomy specimens were graded according to both 2005 Gleason and 2014 ISUP five-tier Gleason grading system (five-tier GG system). Upgrading and downgrading rates on radical prostatectomy were first recorded for both classifications and then compared. The accuracy of the biopsy for each histological classification was determined by using the kappa coefficient of agreement and by assessing sensitivity, specificity, positive and negative predictive value. Results: The five-tier GG system presented a lower clinically significant upgrading rate (1895/9703: 19,5% vs 2332/9703:24.0%; p = .001) and a similar clinically significant downgrading rate (756/9703: 7,7% vs 779/9703: 8%; p = .267) when compared to the 2005 ISUP classification. When evaluating their accuracy, the new five-tier GG system presented a better specificity (91% vs 83%) and a better negative predictive value (78% vs 60%). The kappa-statistics measures of agreement between needle biopsy and radical prostatectomy specimens were poor and good respectively for the five-tier GG system and for the 2005 Gleason score (k = 0.360 ± 0.007 vs k = 0.426 ± 0.007). Conclusions: The new Epstein classification significantly reduces upgrading events. The implementation of this new classification could better define prostate cancer aggressiveness with important clinical implications, particularly in prostate cancer management.

Original languageEnglish
JournalEuropean Journal of Surgical Oncology
Publication statusAccepted/In press - Jan 1 2018


  • Accuracy
  • Downgrading
  • Gleason score
  • Radical prostatectomy
  • Upgrading

ASJC Scopus subject areas

  • Surgery
  • Oncology


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