Updated Gleason grading from the ISUP Consensus Conference

Major conclusion

Cribriform glands should be assigned a Gleason pattern 4, regardless of morphology.
Glomeruloid glands should be assigned a Gleason pattern 4, regardless of morphology.
Grading of mucinous carcinoma of the prostate should be based on its underlying growth pattern.
Intraductal carcinoma of the prostate without invasive carcinoma should be not assigned a Gleason grade, and a comment as to its invariable association with aggressive invasive prostatic adenocarcinoma should be made.

Morphologies within Gleason patterns

Gleason pattern 4 includes cribriform, fused, and poorly formed glands.
The term "hypernephromatoid" cancer should not be used.
For a diagnosis of Gleason pattern 4, it needs to be seen at 10 times lens magnification.
Occasional poorly formed or fused glands between well-formed glands are insufficient for a diagnosis of Gleason pattern 4.
In the case of borderline morphology between Gleason pattern 3 and pattern 4 with crush artifacts, the lower grade should be favored.
Branched glands are allowed in Gleason pattern 3.
Small solid cylinders represent Gleason pattern 5.
Solid medium or large nests with rosette-like space should be considered Gleason pattern 5.
Presence of unequivocal comedo necrosis, even if focal is indicative of Gleason pattern 5.

Adapted from: Epstein JI, Egevad L, Amin MB, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol 2016; 40:244.

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Updated Gleason grading from the ISUP Consensus Conference