Gleason Patterns Clinical
Description
Prostate cancers are graded using Gleason score or pattern. This data item represents the Gleason primary and secondary patterns from needle core biopsy or TURP.
The pathologist determines the Gleason patterns by looking at the prostate tissue under the microscope. The pathologist assigns a grade to the most predominant pattern (largest surface area of involvement, more than 50% of tissue) and a grade for the secondary pattern (second most predominant) based on published Gleason criteria. When a patient undergoes radical prostatectomy, the pathologist may look for a third or tertiary pattern in the specimen. When Gleason pattern 5 is present as a tertiary pattern, its presence should be indicated in the pathology report, as a high Gleason pattern appears to be an indicator for worse outcome (shortened time to recurrence). Studies indicate that a Gleason score 7, with tertiary pattern 5, is associated with a worse prognosis than without tertiary pattern 5 and is similar to the prognosis for Gleason score 8 – 10.
* For example, in a specimen where the primary Gleason pattern is 3, the secondary is 4 and there is less than 5% Gleason 5, the report should indicate a Gleason score of 7 (3+4) with tertiary Gleason pattern 5. Gleason grades (patterns) range from 1 (small, uniform gland) to 5 (lack of glands, sheets of cells.)
For the Gleason Patterns data items, there is a long list of codes and definitions in the table, but it may be easier to assign a value if you understand the structure of the code. This is a two-digit field.
* First digit is the Gleason primary pattern value
* Second digit is the Gleason secondary pattern value
The Gleason system for grading prostate cancer is the one recommended by the AJCC and College of American Pathologists. The following related data items are used to collect information on Gleason.
Rationale
Gleason Patterns Pathological is a Registry Data Collection Variable for AJCC. This data item was previously collected as Prostate, CS SSF #9.
Additional Info
**Source documents:** pathology reports from needle biopsies, transurethral resection of prostate/bladder, or simple prostatectomy that contains prostate tissue
For further information, refer to the **Prostate** cancer protocol published by the College of American Pathologists for the AJCC Staging System *Prostate*
Notes
**Note 1:** **Physician Statement**
* Physician statement of Gleason Patterns Clinical can be used to code this data item when there is no other information available.
**Note 2:** **Procedures**
* Code the Gleason Patterns Clinical from a needle core biopsy, trans rectal ultrasound (TRUS) guided biopsy, transurethral resection of prostate (TURP), and/or simple prostatectomy in this field.
* Gleason primary and secondary patterns provided for any prostate tissue identified from a transurethral resection of a bladder tumor (TURBT) specimen can also be used in this field
**Note 3:** **Neoadjuvant Treatment**
* Code the Gleason primary and secondary patterns prior to neoadjuvant treatment.
**Note 4:** **Gleason Grading**
* Usually, prostate cancers are graded using Gleason score or pattern. Gleason grading for prostate primaries is based on a 5-component system (5 histologic patterns). Prostatic cancer generally shows two main histologic patterns. The primary pattern, the pattern occupying greater than 50% of the cancer, is usually indicated by the first number of the Gleason grade, and the secondary pattern is usually indicated by the second number. These two numbers are added together to create a pattern score.
* If there are two numbers, assume that they refer to two patterns (the first number being the primary pattern and the second number the secondary pattern), and sum them to obtain the score.
* If only one number is given, and it is less than or equal to 5, assume that it describes a pattern (since scores of 5 or less would reflect Primary or Secondary Pattern Scores of 1 or 2). Code the number as the primary pattern and code the secondary pattern as Unknown.
* * For ***example,*** if only one number is given and it is a 3, code "39" for Gleason Patterns and "X9" for Gleason Score.
* If only one number is given, and it is greater than 5, assume that it is a score.
* * For ***example,*** if only one number is given, and it is a 7, code "X6" for Gleason Patterns and "07" for Gleason Score.
* If the pathology report specifies a specific number out of a total of 10, the first number given is the score.
* * For ***example,*** if the pathology report says Gleason 7/10, code "07' for Gleason Score and "X6" for Gleason Patterns.
**Note 5:** **Different patterns**
* If different patterns are documented on multiple needle core biopsies, code the pattern that reflects the highest or most aggressive score regardless of if the pathologist provides an overall pattern in a final summary. If different patterns equal the same high score, give priority to the highest primary pattern and then the highest secondary pattern.
* For ***example,*** both Gleason 3, 4 and Gleason 4, 3 equal Gleason score 7; code 43. Do not mix patterns from multiple specimens.
**Note 6:** **Multiple procedures**
* If multiple procedures are performed (e.g., needle core biopsy, trans rectal ultrasound (TRUS) guided biopsy, transurethral resection of prostate (TURP), and/or simple prostatectomy), code the pattern that reflects the highest score.
**Note 7:** **Related data item**
* The clinical score is recorded in the related data item 3840: Gleason Score Clinical.
Coding Guidelines
**1)** **Code X6** If the only information available is the Gleason Score
**2)** **Code X7** if no needle core biopsy/TURP is done
**3)** **Code X9** when only Grade Group is available, do not infer Gleason Primary and Secondary Pattern from Grade group
***Examples***
**1)** Gleason 3+3 = Patterns 33, Score 06
**2)** Gleason 4+3 = Patterns 43, Score 07
**3)** Gleason 4 (Assume a number in the range 2-5 is a primary pattern and code unknown (9) in the second digit) = Patterns 49, Score X9
**4)** Gleason 7 (Assume a number in the range 6-10 is a score) = Pattern X6, Score 07
**5)** Gleason 10 (only combination of values that equals 10 is 5+5) = Pattern 55, Score 10
**6)** Needle core biopsy or TURP not done = Patterns X7, Score X7
**7)** Gleason not done, or unknown if done = Patterns X9, Score X9
Default
X8
Metadata
SSDI
| Code |
Description |
| 11 |
Primary pattern 1, secondary pattern 1 |
| 12 |
Primary pattern 1, secondary pattern 2 |
| 13 |
Primary pattern 1, secondary pattern 3 |
| 14 |
Primary pattern 1, secondary pattern 4 |
| 15 |
Primary pattern 1, secondary pattern 5 |
| 19 |
Primary pattern 1, secondary pattern unknown |
| 21 |
Primary pattern 2, secondary pattern 1 |
| 22 |
Primary pattern 2, secondary pattern 2 |
| 23 |
Primary pattern 2, secondary pattern 3 |
| 24 |
Primary pattern 2, secondary pattern 4 |
| 25 |
Primary pattern 2, secondary pattern 5 |
| 29 |
Primary pattern 2, secondary pattern unknown |
| 31 |
Primary pattern 3, secondary pattern 1 |
| 32 |
Primary pattern 3, secondary pattern 2 |
| 33 |
Primary pattern 3, secondary pattern 3 |
| 34 |
Primary pattern 3, secondary pattern 4 |
| 35 |
Primary pattern 3, secondary pattern 5 |
| 39 |
Primary pattern 3, secondary pattern unknown |
| 41 |
Primary pattern 4, secondary pattern 1 |
| 42 |
Primary pattern 4, secondary pattern 2 |
| 43 |
Primary pattern 4, secondary pattern 3 |
| 44 |
Primary pattern 4, secondary pattern 4 |
| 45 |
Primary pattern 4, secondary pattern 5 |
| 49 |
Primary pattern 4, secondary pattern unknown |
| 51 |
Primary pattern 5, secondary pattern 1 |
| 52 |
Primary pattern 5, secondary pattern 2 |
| 53 |
Primary pattern 5, secondary pattern 3 |
| 54 |
Primary pattern 5, secondary pattern 4 |
| 55 |
Primary pattern 5, secondary pattern 5 |
| 59 |
Primary pattern 5, secondary pattern unknown |
| X6 |
TURP and/or Biopsy done, primary pattern unknown, secondary pattern unknown |
| X7 |
No needle core biopsy/TURP performed |
| X8 |
Not applicable: Information not collected for this case
(If this information is required by your standard setter, use of code X8 may result in an edit error.) |
| X9 |
Not documented in medical record
Gleason Patterns Clinical not assessed or unknown if assessed
Unknown whether TURP and/or Biopsy done |
