The Gleason Score is a grading system used to evaluate the aggressiveness and behavior of prostate cancer. Your doctor may use the Gleason Score to create a treatment plan in combination with other factors, including:

  • The stage of the cancer
  • PSA level
  • The patient’s overall health and age
  • Whether cancer has spread to other organs
  • Whether cancer is found in one or both sides of the prostate
  • The patient’s desire to have treatment or no treatment at all

How Samples are Tested

The Gleason Score is determined using samples from a prostate biopsy. A hollow needle is inserted either through the rectum or the perineum (the skin between the anus and the scrotum) to retrieve small samples of prostate tissue called cores. The doctor may repeat the process several times to collect biopsy cores from different areas of the prostate.

The biopsy cores are then sent to a lab for testing, where a pathologist examines the samples under a microscope. If cancer cells are present, the pathologist will use the Gleason Score and/or Gleason Grade to describe their aggressiveness.

Gleason Score and Gleason Grade

Two scales are used to describe the likelihood that prostate cancer cells will spread and potentially require treatment. The Gleason Score is the sum of two numbers corresponding to the most common and second-most common appearance of cancer cells in the sample.

The Gleason Grade provides a simplified grouping across five categories, including a low grade representing idle prostate cancer. On both scales, higher scores imply a higher chance that cancer will spread quickly.

  • Gleason 3+3 = 6 – Grade 1 – Low/Very Low Risk

Only individual discrete well-formed prostate cells. Cancer cells look similar to normal cells and will likely grow slowly or not at all.

  • Gleason 3+4 = 7 – Grade 2 – Intermediate Risk

Represents predominantly well-formed prostate cells with a lesser component of poorly-formed cells or groups of cells. The cancer is likely to grow and spread at a moderate pace. However, with a primary grade of 3 and a secondary grade 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.

  • Gleason 4+3 = 7 – Grade 3 – Intermediate Risk

Predominantly poorly-formed cells or groups of cells with a lesser component of well-formed glands. The cancer is likely to grow and spread at a faster pace than a Grade 2 grade. Treatment may be needed to prevent issues.

  • Gleason 4+4, 3+5, 5+3 = 8 – Grade 4 – High Risk

Only poorly-formed cells or groups of cells, some well-formed groups of cells with a lesser component lacking, or normal prostate tissue structure. With a Gleason Grade of 4, the cancer is aggressive and likely to grow and spread more rapidly.

  • Gleason 4+5, 5+4, 5+5 = 9/10 – Grade 5 – Very High Risk

Lacks normal prostate tissue structure with or without regions with poorly-formed cells or groups of cells. The cells look very abnormal; the cancer is aggressive and is likely to grow and spread rapidly.

Prostate Cancer Testing

Your doctor may speak to you about prostate cancer screening and further testing if you are experiencing symptoms or have certain risk factors for developing prostate cancer.

One of the best things you can do for your prostate health is to be proactive and gather information from trusted resources. It’s important to advocate for yourself and discuss with your doctor about your risk factors, any symptoms you may be experiencing, and whether screening is right for you.

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Jan 2, 2023 | TULSA Procedure

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