Histologic grading and the practicing urologist.

Abstract

Over the past 60 years, pathologists have identified three histologic features, tumor volume, glandular differentiation, and nuclear anaplasia, as important prognosticators of the malignant potential of prostatic adenocarcinoma. Several histologic grading systems have emerged to assess these morphological and cytological features, but problems with objectivity and reproducibility have been encountered. The failure of grading systems to predict accurately the malignant potential of individual tumors and the paucity of therapeutic options available have prevented many urologists from adopting these systems. Recent progress among stage A lesions has highlighted the clinical relevance of histologic grading systems, but advances are needed in prognostic techniques and therapeutic modalities before the practicing urologist can apply histologic information clinically among the majority of his patients.