The Gleason score remains the most reliable prognosticator in men with prostate 
cancer. One of the recent important modifications in the Gleason grading system 
recommended from the International Society of Urological Pathology consensus 
conference is recording the percentage of Gleason pattern 4 in the pathology 
reports of prostate needle biopsy and radical prostatectomy cases with Gleason 
score 7 prostatic adenocarcinoma. Limited data have indeed suggested that the 
percent Gleason pattern 4 contributes to stratifying the prognosis of patients 
who undergo radical prostatectomy. An additional obvious benefit of reporting 
percent pattern 4 includes providing critical information for treatment 
decisions. This review summarizes and discusses available studies assessing the 
utility of the percentage of Gleason pattern 4 in the management of prostate 
cancer patients.