Even in the absence of hormonal therapy, the prostatic adenocarcinoma would not be graded as a Gleason score of 10. which implies no glandular differentiation or glandular differentiation confined to cribriform glands with comedo necrosis
In the absence of hormonal therapy this Gleason score might have been reasonable due to the predominance of ill-defined glands and the presence of single cells; however, due to the patient’s treatment with hormonal therapy, the Gleason score will be artifactually elevated and it is best not to provide it.
Even in the absence of hormonal therapy, this Gleason score would be incomplete. The adenocarcinoma represented in this slide is a mixture of patterns 3, 4, and 5. Although it is feasible, depending on the morphology of the tumor volume in the remaining slides, that the Gleason score of the entire radical prostatectomy be a 7 (3 + 4), it is necessary to mention the Gleason grade 5 component, since it is the highest grade available. In the absence of hormone therapy, the Gleason score would have been either 9 (4 + 5) or 7 (3 + 4) with a tertiary component of Gleason grade 5, depending on whether the Gleason grade 5 component is more than 5% or less than 5% of tumor volume, respectively. Either way, Gleason grade 5 should be included.
Even in the absence of hormonal therapy, this Gleason score would be incorrect, due to the predominance of Gleason grade 4, characterized by ill-formed or fused glands.
Due to the realization that hormone therapy for prostate cancer can artifactually increase the Gleason score, and, therefore, falsely portray a worse prognosis, it has been decided not to grade carcinoma with hormone therapy treatment effect. In cases where a clinical history of hormonal therapy is provided, but the carcinoma does not exhibit the morphologic changes of hormonal therapy seen in this case, the carcinoma should be assigned a Gleason score and a comment should be made in regards to the lack of histologic signs of hormonal therapy.