Volume 69, Issue 4, Pages 592-598 (April 2016) Clinical Utility of Quantitative Gleason Grading in Prostate Biopsies and Prostatectomy Specimens  Guido Sauter, Stefan Steurer, Till Sebastian Clauditz, Till Krech, Corinna Wittmer, Florian Lutz, Maximilian Lennartz, Tim Janssen, Nayira Hakimi, Ronald Simon, Mareike von Petersdorff-Campen, Frank Jacobsen, Katharina von Loga, Waldemar Wilczak, Sarah Minner, Maria Christina Tsourlakis, Viktoria Chirico, Alexander Haese, Hans Heinzer, Burkhard Beyer, Markus Graefen, Uwe Michl, Georg Salomon, Thomas Steuber, Lars Henrik Budäus, Elena Hekeler, Julia Malsy-Mink, Sven Kutzera, Christoph Fraune, Cosima Göbel, Hartwig Huland, Thorsten Schlomm  European Urology  Volume 69, Issue 4, Pages 592-598 (April 2016) DOI: 10.1016/j.eururo.2015.10.029 Copyright © 2015 European Association of Urology Terms and Conditions

Fig. 1 Impact of the Gleason pattern on patient prognosis (time to biochemical recurrence). (A) Gleason categories with Gleason 7 separated into 3+4 and 4+4; (B) further subdivision of Gleason categories 3+4 and 4+3 into cancers with low and high fractions of Gleason 4, with 3+4 low=≤25% Gleason 4, 3+4 high=26-49% Gleason 4, 4+3 low=50–74% Gleason 4 and 4+3 high=≥75% Gleason 4; and (C) “quantitative” Gleason with patient groups defined by the fraction of Gleason 4. PSA=prostate specific antigen. European Urology 2016 69, 592-598DOI: (10.1016/j.eururo.2015.10.029) Copyright © 2015 European Association of Urology Terms and Conditions

Fig. 2 Impact of the Gleason score in the biopsy on the likelihood of finding an unfavorable Gleason score in a subsequent prostatectomy specimen. Comparison of the Gleason in the biopsy and the radical prostatectomy based on (A) the worst Gleason found in all biopsies and (B) the average Gleason across all biopsies. (C) Same analysis as in A and B but with the average biopsy Gleason score being further subdivided according to the fraction of Gleason 4 into cancers with 3+4 low (≥25% Gleason 4), 3+4 high (25-49% Gleason 4), and 4+3 low (50–74% Gleason 4) or 4+3 high (75-94% Gleason 4). (D) Further subdividing of the biopsy Gleason score according to the fraction of Gleason 4 cancer cells. All analyses are statistically significant (p<0.0001 each). RPE=radical prostatectomy. European Urology 2016 69, 592-598DOI: (10.1016/j.eururo.2015.10.029) Copyright © 2015 European Association of Urology Terms and Conditions

Fig. 3 Extra value provided by the average (quantitative) Gleason grade. Comparison of the quantitative Gleason score with the radical prostatectomy score in subsets of cancers with identical worst (maximal) Gleason score seen in the biopsy. Max=maximum; RPE=radical prostatectomy. European Urology 2016 69, 592-598DOI: (10.1016/j.eururo.2015.10.029) Copyright © 2015 European Association of Urology Terms and Conditions