Prostate Cancer and the Gleason Score

Determining the extent of prostate cancer is important for predicting the course of the disease and in choosing the best treatment. Results from the digital rectal exam, PSA tests and prostate biopsy give the urologist a good idea of whether the cancer is confined to the prostate or has spread outside the gland.

The pathologist’s examination of the biopsy specimen is crucial. After studying the characteristics of the tumor, the pathologist assigns a Gleason score to the cancer. The Gleason score is the most important factor in predicting the current state of the prostate cancer and the success of any treatment. This Gleason score is based on tumor grade, which is an indication of the tumor’s aggressiveness. The tumor grade reflects how far the cancer cells deviate from normal, healthy cells.


Normal prostate epithelial cells form highly organized glands, with well-defined borders. Cancer cells, in contrast, display various degrees of disorganization and distortion. Cancers whose cells appear closest to normal are considered grade 3 and generally are the least aggressive; those with highly irregular, disorganized features are classified as grade 4 or 5 and generally are the most aggressive.

The Gleason score is derived by determining the two most prevalent organizational patterns in the tumor, assigning each a grade, and then adding the two numbers together. For example, if the most common pattern — the primary grade — is 3 and the next most common pattern — the secondary grade — is 4, the Gleason score would be 7 or 3+4. But if the primary grade is 4 and the secondary grade is 3, the Gleason score would be 4+3, and this would be considered to be more aggressive. In other words, the primary grade carries more weight than the secondary pattern in determining the aggressiveness of the cancer.

Most doctors classify a Gleason score of 6 as a low-grade tumor, a Gleason score of 7 as intermediate, and Gleason scores of 8, 9 and 10 as high grade. Gleason scores of 8 to 10 are associated with the least favorable outlook.

You Can Beat Prostate Cancer: And You Don’t Need Surgery to Do It

Source: Johns Hopkins Health Alerts

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