The Gleason grading system is used to assign a score that measures how aggressive prostate cancer. The Gleason score is evaluated by looking at tiny samples of prostate tissue taken during a biopsy. In the biopsy, a tiny cores of tissue is taken from the prostate gland and studied under a microscope.
A pathologist studies these samples under a microscope and assigns a score based on how abnormal the cells and tissues appear. This score helps doctors and patients understand the severity of prostate cancer and assists them in deciding on the best course of treatment.
Gleason Score and International Society of Urological Pathology (ISUP) Grade Groups
The new, ISUP prostate grading system expands on the Gleason grading system and provides a more simplified grouping. In the Gleason system, a grade of 2-10 can be assigned, with 6 being the lowest grade that defines cancer. The ISUP grading system includes only 5 grade groups, all describing cancer, and starts with Grade Group 1. Starting the grading system at 1 instead of 6 can reduce the overtreatment of less aggressive disease.
Here is the correspondence between Gleason score and ISUP Grade Group:
- Gleason 3+3 = 6 – Grade Group 1
- Gleason 3+4 = 7 – Grade Group 2
- Gleason 4+3 = 7 – Grade Group 3
- Gleason 4+4, 3+5, 5+3 = 8 – Grade Group 4
- Gleason 4+5, 5+4, 5+5 = 9/10 – Grade Group 5
Read more details about the ISUP Grade Groups here. (refer to Epstein et al 2016 Am J Surg Path)
A Detailed Look into Gleason Score 4+3
A Gleason Score of 4+3 represents a moderately aggressive form of prostate cancer. In this case, the primary or most predominant pattern has a grade of 4, and the secondary pattern has a grade of 3.
The two patterns are added together to obtain the Gleason Score of 7 (4+3). However, it is important to note that a Gleason Score of 7 can also represent Gleason pattern 3+4 disease. The order of the numbers matters because the first number represents the primary or most common pattern, while the second number represents the secondary or second most common pattern.
A Gleason Score of 4+3 is considered more aggressive than a 3+4 score because the primary pattern (grade 4) indicates a higher degree of cancer cell abnormality and disorganization. Generally, a Gleason Score of 7 indicates moderately aggressive prostate cancer, but a 4+3 Gleason score is associated with a higher risk of progression and poorer outcomes compared to a 3+4 score. In fact, the ISUP grading system assigns a different grade to each of these: Gleason score 7=3+4 is Grade Group 2, while Gleason score 7=4+3 is Grade Group 3. As always, it is essential to discuss the Gleason Score and other diagnostic results with your healthcare team. Your caregivers will take into account various factors, such as your age, overall health, and the stage of the cancer, to determine the most appropriate treatment plan for your specific situation.
Next Steps After a Gleason Score of 4+3
If a prostate biopsy reveals cancer cells that appear almost normal and lead to a Gleason Score of 2, it represents a very low-risk, non-aggressive form of prostate cancer. After a Gleason Score of 2, the next steps would involve discussing the results with your healthcare team. Treatment options could include active surveillance (monitoring the cancer closely with regular follow-ups) or localized treatments.
Blog posts from Profound Medical are for general information only. The content should not be considered medical advice. If you are in need of professional medical advice or assistance, please reach out to your local doctor or clinic.
Frequently Asked Questions
How is a Gleason Score Determined?
After a patient receives a prostate cancer diagnosis, the doctor examines the two most common cell patterns in the patient’s tissue sample, assigns a grade to each pattern, and combines these grades to determine the total Gleason score.
To calculate a patient’s Gleason score, a pathologist must:
- Assign a grade to the primary or most common cell pattern in the tissue sample, known as the primary pattern.
- Assign a grade to the second most common cell pattern in the tissue sample, known as the secondary pattern.
- Add the two grades together.
For example, if the primary cell pattern is determined to be a 3 and the secondary cell pattern is graded as a 4, the Gleason score would be 7.
What Does a Gleason Score of 4+3 Mean in Prostate Cancer?
A Gleason score of 4+3 means that the majority of the cancer cells are Gleason pattern 4 (more aggressive), with a smaller component of Gleason pattern 3 (less aggressive). This score falls into Grade Group 3, indicating moderate aggressiveness.
How is Grade Group 3 Different from Other Grade Groups in Prostate Cancer?
Grade Group 3, corresponding to a Gleason score of 4+3, indicates an intermediate risk of cancer progression. It is more aggressive than Grade Groups 1 and 2 but less aggressive than Grade Groups 4 and 5.
How Does a Gleason Score of 4+3 Impact the Prognosis of Prostate Cancer?
The prognosis for patients with a Gleason score of 4+3 can vary. Many patients can achieve favorable outcomes with appropriate treatment. The risk of recurrence is higher than for lower Gleason scores but lower than for higher scores. Factors such as the cancer’s stage, PSA levels, the patient’s overall health, and treatment response play a significant role in the prognosis. Regular monitoring and follow-up care are essential for effective disease management.
How Can Gleason 4+3 Prostate Cancer Be Managed with Active Surveillance?
Active surveillance might be an option for some patients with Gleason 4+3=7 prostate cancer, particularly if the cancer is localized, PSA levels are stable, and the cancer volume is low. Older patients or those with significant health issues might prefer this approach to avoid treatment side effects. Active surveillance involves regular monitoring through PSA tests, digital rectal exams, and repeat biopsies to detect any early progression. The decision should be made with a healthcare provider, considering the patient’s overall health, preferences, and ability to adhere to the follow-up schedule.
Are There Lifestyle Changes That Can Help Manage Prostate Cancer with a Gleason Score of 4+3?
Yes, lifestyle changes such as maintaining a nutritious diet, regular physical activity, avoiding smoking, and limiting alcohol consumption can help manage prostate cancer and improve overall well-being. Following the treatment plan and attending all follow-up appointments is also crucial.
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