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

If you’ve had a prostate biopsy, you’ve probably heard your healthcare team mention a 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.

When is a Prostate Biopsy Necessary?

There are several reasons why your primary care physician or urologist will request a biopsy be performed, including:

• You’ve had more than one PSA test that shows a steadily increasing PSA level without another cause.

• Your doctor finds a lump when performing a digital rectal exam.

• You've had a previous biopsy with a normal result, but new tests show an elevated PSA level.

A core biopsy is most commonly used to sample several small areas within the prostate. This is because you can have abnormal cells in some areas of the prostate, while other areas will look healthy. The biopsy samples are examined by a pathologist who will look for abnormal cells. That will result in a report that describes how different the cells looked under the microscope. This is when a Gleason score is determined.

What’s a Gleason Score?

A Gleason score is a number assigned to the cancer based on the results of a prostate biopsy. It’s used to predict how fast the prostate cancer is growing.

During the prostate biopsy, the doctor will take small samples from a few areas. These samples are tested to see how different the cells look under a microscope compared to normal, healthy prostate cells.

The most predominant cell pattern will be the first number in the Gleason score result. The second most predominant cell pattern is the second number in the Gleason score.

If the total of these two numbers is 6 or less, it’s not usually considered a prostate cancer diagnosis, and your doctor may recommend a repeat biopsy in the next few years.

If the total is 3+4=7, the predominant cell pattern is closer to normal. You will likely need to be under active surveillance to determine when treatment needs to begin.

Treatments are likely to begin if the Gleason score is 4+3=7 or if it’s 8 or higher.

Is Gleason Score the Same as the Grade of Cancer?

The International Society of Urological Pathology released an updated prostate cancer grading system called Grade Groups in 2014. This grade group breaks down into five categories from low risk to high risk of being aggressive cancer.

• Grade Group 1: Gleason score of 6 or less

• Grade Group 2: Gleason score of 3+4=7

• Grade Group 3: Gleason score of 4+3=7

• Grade Group 4: Gleason score of 8

• Grade Group 5: Gleason score of 9 or 10

The higher the grade, the more likely the cancer is to be aggressive.

What Happens if You Have a 3+4=7?

If your Gleason score is 6 or less, you will not likely need treatments until another prostate biopsy is performed.

When the Gleason score shows that some cancer cells are present but not predominant, an approach called watchful waiting can be used. This is also sometimes called active surveillance. The cancer is slow growing and doesn’t need treatment immediately, but it needs to be watched so that treatment can begin once it advances further.

Your oncologist will make recommendations on when to have another biopsy and when to start treatments.

Related Reading: Commonly Asked Questions and Answers About Prostate Cancer

When Prostate Cancer Treatment is Required

Depending on the Grade Group, or the Gleason score, it may be time to begin treatments.

As with other types of cancer, the earlier prostate cancer is diagnosed, the easier it is to treat. When the timing is right to begin, the oncologist will review options with you. Not everyone needs to have surgery to remove the prostate. Because a prostatectomy can have lasting side effects, it’s a good idea to evaluate other treatments, such as radiation therapy and/or hormone therapy.

Radiation Therapy for Prostate Cancer

Radiation therapy for prostate cancer can be internal, also called “seeds” or brachytherapy. The radiation pellets are inserted into the prostate and left to break down and deliver radiation slowly to the prostate. External beam radiation therapy can also be used with or without brachytherapy.

Hormone Therapy for Prostate Cancer

Because prostate cancer grows due to male hormones, it’s possible to slow or stop the growth of the cancer cells by reducing the amount of hormones in the body. This can be done with medication in most cases but can be done surgically.

Other Prostate Cancer Treatments

There are other prostate cancer treatments as well, and the right set depends on the stage and grade group of the cancer. These can be:

• Surgery to remove the prostate

• Targeted therapy

• Immunotherapy

• Chemotherapy

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