ISUP Grades 1 – 5

 

It is well known that some Gleason scores have similar outcome, while the distinction between GS 3+4=7 and 4+3=7 is clinically relevant. At the ISUP 2014 consensus conference it was decided that the following grouping is useful for clinicians and patients.

 

ISUP grade 1             GS≤6

ISUP grade 2             GS 3+4=7

ISUP grade 3             GS 4+3=7

ISUP grade 4             GS 8

ISUP grade 5             GS 9-10

 

This grading is just another way of presenting Gleason grading data. It does not add information to the Gleason grading and may be seen as a simplified way of giving advice to the patient. The Gleason grade should still be used in parallel, i.e. Acinar adenocarcinoma of the prostate Gleason score 3+3=6 (ISUP grade 1).

 

The nomenclature of this ISUP 2014 grading has been a matter of debate. It was decided that the 4th edition of the WHO classification would not support any specific nomenclature but allow pathologists to choose their preferred terminology. The descriptive wording grade groups was used in the text. Some have used this in clinical practice which has led to confusion. The acronym GG has previously been used for Gleason grade. The ISUP grading is not a grouping of Gleason grades but of Gleason scores. Other terms that are currently used are:

ISUP grade groups, ISUP grade grouping, prognostic grade groups and ISUP/WHO grade.