The Gleason Method relates to an eyeball estimate of RISK of metastasis. ARTERRA uses AI to compare hopefully a good sample of tissue... (IMHO: ...per a 3T-multiparametric dye enhanced MRI, ideally read not by general radiologist but rather one who is steeped in GU rad-pathology. A subsequent CT-MRI fusion perineal targeted biopsy would be preferred. It has fewer infections and can visualize the anterior of the prostate though an infrequent disease site.

Mentioned earlier in a post: Post & Pre-surgical prostate gland only samples were concordant 60-75%, (15-25% worse if corrected (worse minus better) but still it is an estimate of RISK of metastasis. The studies incidentally were summarized from far earlier data sets. Their publication dates occurred probably a decade later than the raw data.

In the interim PSMA PET CT scan 'ruling in' or 'ruling out' of 'mets' (...for the most part) have become almost universally applied in follow-up to increasing classical Gleason RISK of metastasis in gland contained findings. DECIPHER genomic tests, ARTERRA,
AI review of biopsy, even AI review of MRIs [deepviewimaging.com] can help in the decision process. Other intraglandular features & considerations remain such as tumor burden: amount and size, cribriform types of '4' Gleason, intraductal, extension into seminal vessels, etcetera. These all are factors that can now be taken into consideration by an 'at arm's length' GU medical oncologist. Let us realize that employees of corporations of even the best institutions tow the line and are often in the rear guard, i.e. , looking in dollar incentivized rear view therapeutic mirrors. The specter of micro-mets in low burden disease can be addressed with annual
mpMRIs and quarterly PSA tests. Spot radiotherapy would be an option in that unlikely outcome.