Histopathological Profile of Prostatic Lesions and the Role of Gleason Score in Surgical Treatment Decision-Making

<b>Introduction:</b> The Gleason score plays a key role in risk stratification and surgical treatment selection for prostate cancer. This study evaluates the correlation between Gleason score, patient age, and tumor aggressiveness, with implications for medical practice. <b>Methods:</b> This retrospective study included 215 patients from Sf. Apostol Andrei Clinical Emergency Hospital of Constanta County (2023-2024) with histopathologically confirmed prostate lesions. Demographic variables (age), Gleason score (classified according to ISUP 2019), and histological grade were analyzed. Data were statistically analyzed using t tests, ANOVA, and logistic regression. While international guidelines provide a standardized framework for management, local and regional variations in healthcare access, diagnostic pathways, and patient preferences significantly influence real-world clinical practice. This study aims to describe the histopathological spectrum of prostatic lesions and evaluate the prognostic relevance of the Gleason score in surgical decision-making within the specific context of a Romanian tertiary care center. By highlighting regional particularities, such as the high burden of aggressive disease and the challenges in implementing active surveillance, our findings contribute to a more nuanced understanding of global prostate cancer care. <b>Results:</b> Benign prostatic hyperplasia (BPH) accounted for 42.8% of cases, PCa for 44.7%, and urothelial carcinoma for 8.4%. Among prostate cancers, 87.5% had clinically significant disease (Gleason >=7), with 29.2% high-risk (Gleason 8-10). Gleason 7 was most frequent (58.3%), predominantly 3+4. A significant correlation was observed between advanced age ( >70 years) and tumor aggressiveness (OR = 2.3; 95% CI: 1.4-3.8). Radical prostatectomy was primarily chosen for Gleason scores >=7, with higher complication rates in older patients. <b>Conclusions:</b> Advanced age and a high Gleason score are independent factors of tumor aggressiveness. Early surgical intervention in patients with Gleason >=7 improves oncological outcomes. Integrating histopathology with multiparametric MRI and molecular biomarkers could optimize management of these patients.