Understanding Prostate Cancer: The

Gleason Scale

 Scoring
 Other factors
 Scoring levels
 Outlook
Knowing the numbers

If you or a loved one has been diagnosed with

prostate cancer, you may already be familiar
with the Gleason scale. It was developed by
physician Donald Gleason in the 1960s. It
provides a score that helps predict the
aggressiveness of prostate cancer.

A pathologist begins by examining tissue

samples from a prostate biopsy under a
microscope. To determine the Gleason score,
the pathologist compares the cancer tissue
pattern with normal tissue.

According to the National Cancer Institute

(NCI)Trusted Source, cancer tissue that looks
most like normal tissue is grade 1. If the
cancer tissue spreads through the prostate
and deviates widely from the features of
normal cells, it is grade 5.

The sum of two numbers

The pathologist assigns two separate grades

to the two predominant cancer cell patterns in
the prostate tissue sample. They determine
the first number by observing the area where
the prostate cancer cells are most prominent.
The second number, or secondary grade,
relates to the area where the cells are almost
as prominent.

These two numbers added together produce

the total Gleason score, which is a number
between 2 and 10. A higher score means the
cancer is more likely to spread.

When you discuss your Gleason score with

your doctor, ask about both the primary and
secondary grade numbers. A Gleason score
of 7 can be derived from differing primary and
secondary grades, for example 3 and 4, or 4
and 3. This can be significant because a
primary grade of 3 indicates that the
predominant cancer area is less aggressive
than the secondary area. The reverse is true if
the score results from a primary grade of 4
and secondary grade of 3.

One of many factors

The Gleason score is only one consideration

in establishing your risk of advancing cancer,
and in weighing treatment options. Your
doctor will consider your age and overall
health as well as additional tests to determine
the cancer stage and risk level. These tests
include:

 digital rectal exam (DRE)

 bone scan
 MRI
 CT scan

Your doctor will also consider your level

of prostate-specific antigen (PSA), a protein
produced by cells in the prostate gland. PSA
is measured in nanograms per milliliter of
blood (ng/ml). PSA level is another important
factor in assessing the risk of advancing
cancer.
What does my Gleason score mean?

Low risk

According to the NCITrusted Source, a

Gleason score of 6 or lower, a PSA level of 10
ng/ml or less, and an early tumor stage places
you in the low-risk category. Together, these
factors mean that the prostate cancer is
unlikely to grow or spread to other tissues or
organs for many years.

Some men in this risk category monitor their

prostate cancer with active surveillance. They
have frequent checkups that may include:

 DREs
 PSA tests
 ultrasound or other imaging
 additional biopsies

Medium risk

A Gleason score of 7, a PSA between 10 and

20 ng/ml, and a medium tumor stage indicates
medium risk. This means that the prostate
cancer is unlikely to grow or spread for
several years. You and your doctor will
consider your age and overall health when
weighing treatment options, which may
include:

 surgery
 radiation
 medication
 combination of these

High risk

A Gleason score of 8 or higher, accompanied

by a PSA level of higher than 20 ng/ml and a
more advanced tumor stage, signifies a high
risk of advancing cancer. In high-risk cases,
the prostate cancer tissue looks very different
from normal tissue. These cancerous cells are
sometimes described as being “poorly
differentiated.” These cells may still be
considered early-stage prostate cancer if the
cancer has not spread. High risk means the
cancer is likely to grow or spread within a few
year

A higher Gleason score generally predicts that

prostate cancer will grow more quickly.
However, remember that the score alone
does not predict your prognosis. When you
evaluate treatment risks and benefits with
your doctor, be sure that you also understand
the cancer stage and your PSA level. This
knowledge will help you decide whether active
surveillance is appropriate. It can also help
guide you in selecting the treatment that best
suits your situation