The Gleason grade defines the severity of prostate cancer and is assessed by analyzing tissue samples taken from the prostate during a biopsy. The Gleason grade is based on examination by a pathologist of the microscopic characteristics of the cancer cells in a biopsy sample of the prostate gland.
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 Gleason Score Grade Groups here. (Refer to Epstein et al 2016 Am J Surg Path)
A Detailed Look Into Gleason Score 3+4
A Gleason Score of 3+4 indicates an intermediate level of aggressiveness in prostate cancer. It is determined by evaluating the microscopic appearance of the cancer cells in a biopsy sample. The Gleason Score is typically reported as a sum of two numbers, representing the predominant and second-most predominant pattern of cancer cells observed.
This Gleason Score of 7. can be assigned when the most commonly occurring pattern of cells is pattern 3, indicating a moderately differentiated cancer, while the second most commonly occurring pattern is 4, indicating a moderately to poorly differentiated cancer. The overall Gleason score of 3+4 suggests intermediate-grade disease, indicating some potential for growth and spread.
Next Steps After a Gleason Score of 3+4
With a Gleason Score of 3+4, the cancer is likely to grow and spread at a moderate pace. However, with a primary score of 3 and a secondary score of 4, the outlook is fairly good. Several years may pass before the cancer becomes a problem, and treatment may be needed to prevent issues.
Management approaches include:
- Active surveillance – Also known as “watchful waiting”, some patients with favourable intermediate-risk disease undergo regular medical tests to determine whether their cancer is getting worse. About half of the men undergoing active surveillance will eventually need to have treatment.
- Radiation or surgery – Although effective at eradicating localized prostate cancer, radiation and surgery both carry the risk of side effects affecting urinary, sexual, and bowel functions such as urinary incontinence and erectile dysfunction.
- Focal therapy – Focal therapy for prostate cancer treatment targets cancer that is localized or contained within the prostate. By treating the “index lesion(s)” (a tumor visible on a diagnostic MRI exam), physicians can avoid damage to surrounding organs and nerves which are important for function and potentially reduce the risk of side effects. while providing relief and peace of mind for patients.
Read our blog to learn more about focal therapy options to treat prostate conditions.
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.
Jul 19, 2023 | TULSA Procedure