Why Is a Gleason Score So Important to Prostate Cancer Patients?

If you’ve been diagnosed with prostate cancer, you’ve probably heard your healthcare team mention your Gleason score, grade, and stage. What is the Gleason score, and what is it used for? Let’s take a closer look at understanding why it’s so important.

What’s a Gleason Score?

A Gleason score is used to predict how fast prostate cancer is growing. If your Gleason score is high or has increased over time, your oncologist may recommend beginning active prostate cancer treatment. In making this decision, the Gleason score is one of the most important measurements in your pathology report. It’s based on the five patterns of how normal cells change into tumor cells. Grade 1 cells look like normal prostate tissue. With grade 5, the highest grade, cells mutate so much that they no longer resemble normal cells.

Why is a Gleason Score Important?

It lets you and your doctors know the level of severity of your prostate cancer and plays a role in choosing the best treatment options for right now. Your age and general health are also considered when making recommendations. A low Gleason score indicates that you are very low-risk, and the best treatment for you may be active surveillance – or watching and waiting before starting cancer treatment. If you have a high Gleason score, your oncologist will recommend active treatment, such as brachytherapy (internal radiation), external radiation, hormone therapy, and/or surgery.

Active surveillance is usually recommended for those who have:

• Very low to low-risk prostate cancer, also described as stage I or II cancer.

• Cancer that has not spread beyond the prostate gland.

• Cancer can be treated with surgery or radiation therapy if it gets worse.

• A Gleason score of 6 or below; sometimes a combined Gleason score of seven can also receive an active surveillance treatment recommendation.

Surgery, radiation therapy, and/or hormone therapy are recommended for men who:

• Have faster-growing cancer, described as stage III cancer

• Have high-risk, early-stage cancer, but it has not spread

• A Gleason score of 7, 8, or higher; if the cancer is aggressive, growing, and spreading outside of the prostate into nearby tissues and organs, treatment will be recommended right away.

What’s in the Prostate Pathology Report?

A pathology report provides details about your cancer based on what it discovered after analyzing your biopsy. The Gleason score is often listed in this report after testing more than one area of the prostate’s cells.

A needle biopsy is one of the most common ways to diagnose prostate cancer and determine the extent of the cancer. It involves removing tissue from several locations throughout the prostate, each sample being evaluated for abnormal cells. The more abnormal they look, the more likely it is that your cancer will grow and spread (metastasize). This analysis will produce a grade and a Gleason score.

Your oncologist will make recommendations about treatment options based on the grade of your prostate cancer. The grade also provides guidance about how often you should be re-tested.

Two methods are used to grade prostate cancer. You may see one or both grading methods listed in your pathology report. Grade groups are being used more often in modern oncology practices because they provide more accuracy than just using a Gleason score.

• The Gleason system is the traditional grading method using combined scores that range from 2 to 10. Because prostate cancer can develop in different areas of your prostate, and each area can have different levels of severity, the Gleason score reflects the grade for each area (ranging from 1 to 5). Grade 1 indicates slowly growing prostate cancer; grade 5 is rapidly growing cancer. The grades for each area are combined to show your combined Gleason score. For example, if most of your cancer is grade 3 and a smaller amount is grade 4, your Gleason score is 7, and it’s listed as 3+4=7. The first number listed (3 in this example) is the grade for most of the cancer cells. The pathologist will also report if any of the cells were a grade 5. Even in a small amount, grade 5 cells indicate a higher risk of cancer recurrence.

A Gleason combined score of 6 or lower is considered low-grade cancer; 7 means an intermediate grade; 8 to 10 is high-grade cancer. Pathologists rarely assign a Gleason score of 2 to 5. Most scores range from 6 to 10; a Gleason score of 6 is the lowest grade of cancer.

• The Grade Groups system, developed in 2014, grades cancer from 1 to 5, depending on its severity. Grade 1 means the cells look like normal prostate tissue. Grades 2, 3, and 4 have different features and levels of severity. Most prostate cancers are grade 3 or higher. Grade 5 means cells look very abnormal.

This chart compares the two systems:

Read our blog: Understanding the Prostate Cancer Pathology Report

What’s The Difference Between the Cancer’s Stage and Its Grade?

Staging indicates where the cancer is in your body, the size of the tumor and whether it's grown outside of the prostate capsule.

The grade of your cancer is a very important component of staging – but only one component – used to establish your stage of prostate cancer. The grade describes how the cancer cells look under a microscope.

Related Reading: Commonly Asked Questions and Answers About Prostate Cancer

Prostate Cancer Specialists in Brevard County, Florida

The prostate cancer specialists at Cancer Care Centers of Brevard will evaluate your prostate pathology report and discuss treatment options based on the grade and stage of cancer. For many, simply waiting is a viable option. Find out what’s recommended for you or a loved one by requesting an appointment at one of our locations in Merritt Island, Palm Bay, Melbourne, and Rockledge. Our experienced oncologists will provide comprehensive, patient-centered care. We’ll be with you every step of your journey.

Categories: Prostate Cancer