Diagnosis: Adenocarcinoma of the prostate Gleason 4+4=8.   

            Comment: For the reporting of limited secondary patterns of lower grade the recommendation of the ISUP consensus conference (See Case 209) is that one should ignore lower grade patterns if they occupy less than 5% of the tumor area on a needle biopsy. In the present case Gleason grade 4 (Figs. 1 to 5) corresponds to 95% of the extent of the tumor, and Gleason grade 3 (Fig.5) to less than 5%. According to the original Gleason system this case is graded 4+3=7, however, according to the updated Gleason system is 4+4=8.