The Gleason scoring system for prostate cancer has been revised twice, in 2005 and 2014, but it still has many shortcomings. For the purpose of guiding prognosis and treatment, we usually divide the Gleason score into three groups, namely 6, 7, and 8-10 subgroups. the lowest score in the Gleason scoring system is 6, but it is easily misunderstood by patients as their tumor grade is higher. In addition, the 3+4=7 grouping and the 4+3=7 grouping are often misunderstood to have the same meaning. Recently, Jonathan et al. from JHU Medicine constructed a new five-level scoring system based on the current Gleason scoring system, namely, subgroup 1 (Gleason score ≤ 6), subgroup 2 (Gleason score 3+4=7), subgroup 3 (Gleason score 4+3=7), subgroup 4 (Gleason score = 8 ) and subgroup 5 (Gleason score 9-10). The value of the scoring system in guiding patient prognosis was also evaluated using multicenter clinic data, and the results showed that the scoring can more accurately and significantly guide patient treatment and prognosis and reduce overtreatment of prostate cancer. The article was published in a recent issue of European Urology. The study included 20,845 patients who underwent radical prostate cancer resection between 2005 and 2014, along with 5,501 patients who received radiation therapy. The primary outcome indicator was biochemical recurrence. In the surgery group, there were significant differences in recurrence rates in the Gleason score 3+4 subgroup compared with the 4+3 subgroup and in the 8 subgroup compared with the 9 subgroup. Compared to the Gleason score 6 subgroup, the risk ratios for the score 3+4 subgroup, the 4+3 subgroup, the 8 subgroup, and the 9-10 subgroup were 1.9, 5.1, 8.0, and 11.7, respectively. In the radiation therapy group, these differences were less pronounced overall than in the surgery group, possibly because of the increasing use of adjuvant and neoadjuvant endocrine therapy in high-grade prostate patients. This new five-level scoring system had the highest prognostic differences in both the surgery and radiation therapy groups on both univariate and multivariate analyses. Overall, the new prostate cancer scoring system has several advantages: (1) more accurate stratification than the Gleaon scoring system; (2) simplification of the scoring to 5 levels compared to 25 scores in the Gleason system depending on the combination; and (3) a minimum score of 1 instead of 6, potentially reducing overtreatment of prostate cancer. In addition, not only this study supports the value of the new scoring system, but many studies after 2005 have shown that patients with a Gleason score of 6 have the best prognosis and a score of 4+3=7 has a worse prognosis than a score of 3+4=7, while those with a score of 9-10 have the worst prognosis. Of course to avoid confusion, we need to be cautious with this new scoring system in conjunction with the Gleason system until it is widely accepted and used (e.g. Gleason score 3+3=6 [1 subgroup]).