Gleason grade 5 is an important grade because it usually predicts another significant step towards poor prognosis.
Its overall importance for the general population is reduced by the fact that it is less common than grade 4, and it is seldom seen in men whose prostate cancer is diagnosed early in its development. This grade too shows a variety of patterns, all of which demonstrate no evidence of any attempt to form gland units.
Figure 7 shows only a sea of black nuclei with no pattern. The variety of different appearances is less than for grade 4 because there are fewer ways to do nothing! This grade is often called undifferentiated, because its features are not significantly distinguishing to make it look any different from undifferentiated cancers which occur in other organs.
Figure 7: Grade 5 adenocarcinoma, consisting of sheets of cells whose lack of pattern in nuclear arrangement indicates total loss of architecture, seen at higher magnification.
Department of Urology, Stanford University School of Medicine.
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