Dr. Donald F. Gleason, the Minnesota pathologist who developed the Gleason score that is now used almost universally in the United States to predict the likely outcome of prostate cancer, died Dec. 28 of a heart attack at his home in Edina, Minn. He was 88.
"His work is the gold standard for prostate cancer diagnosis and treatment selection," said Dr. Akhouri Sinha, a colleague of Dr. Gleason's at the University of Minnesota Medical School. Researchers have been trying for 40 years to develop a better system to replace it, he said, but without success.
Virtually all of the 186,320 U.S. men who will be diagnosed with prostate cancer this year, according to the American Cancer Society, will know their Gleason score and what it means about the likelihood they will be among the 28,660 who will die from it.
Dr. Gleason was an unknown, junior-grade pathologist at the Minneapolis Veterans Administration Medical Center in 1962 when he was approached by the hospital's chief of urology, Dr. George Mellinger. Mellinger was administering a cooperative research project on prostate cancer involving 14 hospitals and asked Dr. Gleason to develop a standardized rating system for tumors to ease communication between the groups.
At the time, there was no uniform system for determining the grade of prostate tumors -- a measure of how far they had already progressed and of their likely course in the future. Each pathologist pretty much used his own system, which made comparing research results among different groups nearly impossible.
In 1966, Dr. Gleason described his system in a report on 280 patients in the journal Cancer Chemotherapy Reports. The pathologist looks at microscopic samples from the tumor and finds the two most common types of tissue in the tumor, assigning each a score from one to five depending on how closely the tissues resemble normal prostate cells.
A score of one means they are very similar to normal cells, while a score of five means they look nothing at all like normal cells.
Dr. Gleason made a simplified drawing of each of the grades, "probably my most valuable contribution to the grading system. Pathologists, who tend to think in pictures, quickly grasped this graphic presentation."
The Gleason scale was slow to catch on, but in 1987, seven of the leading authorities in urology and urological oncology sent a letter to the editor of the Journal of Urology urging that it be applied uniformly in all publications on prostate cancer. Their recommendation was adopted and the scale quickly came into wide use.
Dr. Gleason spent all of his career at the University of Minnesota and the affiliated VA Hospital, formally retiring in 1988.