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The Gleason Score & Its Role in Prostate Cancer Treatment Planning
If you were recently diagnosed with prostate cancer, your biopsy report probably included a number called the Gleason score. This number indicates to your doctor whether cancer is present, and will influence when to start treatment.
The Gleason score is a grading system. It helps physicians determine how different the prostate cells look under a microscope compared to normal, healthy cells. Understanding your score and how it relates to choosing a treatment plan can help you feel more confident as you discuss your options with your care team.
What is the Gleason score?
The Gleason score is a grading system used to evaluate prostate cancer cells after a biopsy. It helps determine how aggressive the cancer is based on how abnormal the cells appear. Cells that closely resemble normal prostate tissue typically grow more slowly, while those that look very different from normal tissue tend to spread more quickly.
Who determines the Gleason score?
A pathologist determines the Gleason score. After a prostate biopsy, the pathologist analyzes the collected tissue under a microscope and includes the Gleason score in the pathology report. Your urologist or oncologist then uses this information, along with other test results, to develop your treatment plan.
Understanding Grade Groups
Staging
Treatment Planning
Next Steps
How is the Gleason score calculated?
The pathologist identifies the two most common (primary and secondary) cancer cell patterns in the biopsy sample and assigns a score of 1 to 5 to each. These two numbers are added together to create a Gleason score total between 2 and 10. Anything less than 6 is non-cancerous. A typical Gleason score for prostate cancer will be between 6 and 10. A score of 6 means that cancer is present but likely growing slowly and has a low chance of spreading. A score of 10 means that the cancer could be growing quickly and has a high chance of spreading.
Understanding grade groups
The Gleason score is often translated into a grade group. These categories tell the physician how fast the cells are likely to reproduce and how abnormal the cells look under a microscope. There are five grades for prostate cancer. They are related to the Gleason score determined during the biopsy.
- Grade Group 1: Gleason score 6 (3+3)
- Grade Group 2: Gleason score 7 (3+4)
- Grade Group 3: Gleason score 7 (4+3)
- Grade Group 4: Gleason score 8
- Grade Group 5: Gleason scores 9-10
This system helps differentiate cancers that may share the same Gleason score but behave differently. For example, both 3+4 and 4+3 equal 7, but they belong to different Grade groups because the dominant cell pattern indicates how aggressive the cancer is likely to be.
How does the Gleason score affect staging?
The Gleason score is part of the staging process. While imaging and physical exams provide insights into tumor size and spread, the Gleason score provides insight into how aggressively the cancer may behave.
In general, lower Gleason scores indicate slower-growing cancer, while higher scores suggest a greater likelihood of aggressive growth or recurrence. The Gleason score is often used alongside PSA levels, the size of the tumor, and whether lymph nodes or other organs were affected to establish the stage and determine next steps.
How the Gleason score impacts treatment planning
Gleason 6 (Grade Group 3)
A Gleason score of 6 indicates low-risk prostate cancer that typically grows slowly. Many patients may not require immediate treatment. Instead, doctors often recommend active surveillance, which involves regular monitoring through PSA tests, imaging, and repeat biopsies as needed. The goal is to identify any changes in aggression without unnecessary interventions.
Gleason 7 (Grade Groups 3 and 4)
Not all Gleason 7 scores are equal. A score of 3 + 4 = 7 suggests that the less aggressive grade 3 cells are predominant, sometimes allowing for more conservative treatment options. In contrast, a 4 + 3 = 7 score, with dominant grade 4 cells, generally indicates a higher risk of progression, leading to more aggressive treatment recommendations, including surgery, radiation, and/or systemic therapies.
Gleason 8-10 (Grade Group 5)
Scores of 8, 9, or 10 indicate high-grade, aggressive prostate cancers that typically require active treatment strategies. Your oncologist and/or urologist will likely recommend a combination of therapies, including surgery, radiation therapy, targeted therapies, hormone therapy, or chemotherapy. Participation in a clinical trial is also an option.
Next steps after a prostate cancer diagnosis
If you were recently diagnosed with prostate cancer, it’s a good idea to meet with an oncologist who can discuss all treatment options, especially if the cancer is early-stage. The prostate cancer specialists at SCRI Oncology Partners are happy to discuss these options as well as provide a second opinion and discuss if any clinical trials may be available to you.
We’re here when you need us
If you were recently diagnosed or would like a second opinion, request an appointment with one of our experienced cancer doctors right here in Nashville.
We’re here when you need us
If you were recently diagnosed or would like a second opinion, request an appointment with one of our experienced cancer doctors right here in Nashville.
We’re here when you need us
If you were recently diagnosed or would like a second opinion, request an appointment with one of our experienced cancer doctors right here in Nashville.