Significance of the Gleason scoring system after neoadjuvant hormonal therapy

Neoadjuvant hormonal therapy (NHT) induces morphologic changes in prostate adenocarcinoma that result in the assignment of higher Gleason scores on av erage than in pretreatment biopsy specimens, This outcome has led to the re commendation that the Gleason scoring system not be applied to prostate ade nocarcinoma specimens after NHT, We reviewed the radical prostatectomy spec imens of 116 patients who had received NHT. Gleason scores were assigned on the post-treatment specimens by applying the usual criteria; in addition, an estimated pretreatment Gleason score was assigned on the basis of knowle dge of the morphologic alterations associated with NHT, Finally, an estimat e of the degree of therapy effect was assigned: little or no evidence of ho rmonal effect (grade 1) to marked therapy-related changes (grade 3), Both t he post-treatment and the estimated pretreatment Gleason score correlated s ignificantly with biochemical progression (P = 0.03 and P = 0.03, respectiv ely; log-rank test). The degree of therapy effect did not correlate with pr ogression (P = 0.46; log-rank test), This limited analysis suggests that de spite the morphologic alterations induced by NHT, post-treatment Gleason sc ore remains a significant prognostic measure, Further studies in more unifo rmly treated populations are required to confirm this observation.