This Plus That Equals What? What a Gleason Score Tells You About Prost
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This Plus That Equals What? What a Gleason Score Tells You About Prostate Cancer

by -

Laughing Man

Until you’ve had a prostate cancer diagnosis, the term Gleason Score may not mean a lot to you. However, since prostate cancer is the leading cancer among men, the term is an important one to understand. The experts at UnityPoint Health – Finley Hospital’s Wendt Regional Cancer Center help explain Gleason Score.

After receiving a positive diagnosis for prostate cancer, typically the next step is to determine your Gleason Score. The Gleason Score is a grading system used to determine staging, prognosis and can ultimately help make decisions about treatment. After a biopsy a pathologist evaluates the cancerous cells and scores the cancerous cells with two numbers ranging from 1-5.  A 1 indicates the cells look similar to healthy cells; where a 5 indicates advanced mutation.

The first number is based on the most common tumor pattern. However, since the tumor pattern grows differently in various parts of the prostate, an additional number is needed. The second number is determined based on the less common tumor pattern. Numbers one and two are added together to determine the Gleason Score.

Cancers with a higher Gleason Score indicate a more aggressive form of prostate cancer. However, the scale is not necessarily a 2-10 scale. Typically, cancers in the 2-5 range are not advanced enough to require a biopsy, according to the American Cancer Association.  Therefore, the lowest Gleason Score assigned is typically a 6 (3+3=6). The highest Gleason Score, with the worst prognosis, is a 10 (5+5=10). Recently, a new concept of Grade Groups is used to address the misunderstanding in scores. The new Grade Groups range from 1 (most favorable) to 5 (least favorable) and incorporate the Gleason Score. The chart below shows the first and second numbers that make up the Gleason Score, the actual Gleason Score and the Gleason Grade.

Rank of Majority of Cancer Cells

Rank of Minority of Cancer Cells

Gleason Score

Gleason Grade

1, 2, 3

1, 2, 3

6 or less

Grade Group 1

3

4

7

Grade Group 2

4

3

7

Grade Group 3

4

4

8

Grade Group 4

4

5

9

Grade Group 5

5

4

9

Grade Group 5

5

5

10

Grade Group 5

Once you know your Gleason Score or Grade, you can begin to make informed decisions about treatment options. Grade Group 1 is considered low risk and often can result in watchful waiting. Grade Groups 2 and 3 (a Gleason Score of 7) are intermediate risk, while Grade Groups 4 and 5 (Gleason Scores 8-10) are considered high risk. Once a Gleason Score of 7 is reached, treatment options can include various forms or radiation therapy, surgery, hormone therapy, chemotherapy or HIFU. Depending on the type of cancer and the Gleason Score or Grade, radiation therapies could include external beam radiation (including IMRT), brachytherapy, androgen deprivation therapy or radical prostatectomy.

The most important next step is getting consultations from both a radiation oncologist and urologist.  Finley’s Wendt Regional Cancer Center offers consultations with our excellent team of radiation oncologists to help you understand your options and make an informed decision moving forward. In addition, our Tumor Conferences provide multidisciplinary consult on how to best manage challenging cases. 

Read the “10 Most Common Questions that Men ask After Prostate Cancer Diagnosis” for additional information on treatment options.