What is a Gleason Score?


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What is a Gleason score? is a question you may ask about this method of grading your prostate cancer. Your Gleason score is an essential component in determining what treatment will be best for your prostate cancer. The Gleason score can be combined with PSA and other clinical findings to predict local or more advanced disease.

How do I get a Gleason score?

Most patients get a Gleason score after undergoing a prostate biopsy. A prostate biopsy is when your doctor uses a small needle to take a sample of your prostate cells. Often your doctor will repeat this several times and submit the different biopsies for review. The biopsies are then looked at under a microscope to make a diagnosis of prostate cancer based on stage and grade.

Your Gleason score is a way to grade your prostate cancer based on how it looks under a microscope. Scores range from 2 to 10 with higher scores indicating a greater likelihood that a cancer may spread. Additionally, the higher the score the more abnormal your cells are (i.e., different from regular prostate cells).

How is the Gleason score calculated?

A pathologist is a type of doctor who looks at the prostate cells under the microscope. While he or she will see multiple types of cells, the pathologist will pick the two most common cell types and give each of them a score from 1 to 5. The higher the number the more abnormal the prostate cells. The Gleason score is the sum of these two numbers. So if the two most common cell types were graded as 3 and 4 respectively (and often referred to as 3+4), the Gleason score would be 7.

While theoretically a man could have a Gleason score of 2 (1+1), only men who are discovered to have cells as a result of a transurethral resection of the prostate (or TURP) are given this score. Men who are found to have prostate cancer on a biopsy today usually have a Gleason score of 6 or greater.

Interestingly, a man diagnosed with prostate cancer today is more likely to have a higher Gleason score than if he were diagnosed 15 years ago with the same stage of cancer. It is unlikely (but still possible) that prostate cancer is significantly more aggressive; rather it more likely reflects how pathologists score the test today.

In general, a Gleason score of 6 is often viewed as early phase and some of these patients can undergo active surveillance (meaning not treated right away). However, most men with a Gleason score of 6 will progress at some point, so close followup is important if you are not treated right away.

Gleason score controversies

There is some concern today that prostate cancer is over treated. When people hear CANCER they are understandably frightened and scared. Additionally, when a patient Googles “Gleason score” and sees a range from 2 to 10, it is understandable that they might be inclined or predisposed towards treatment, especially while they are worrying about whether they have cancer or not.

It should not be surprising that overtreatment is a problem when patients have a fear of dying from cancer and doctors are scared that they may be sued for counseling patients about a less-aggressive approach and an opportunity for a cure is missed. You need to talk with a doctor you trust to help determine what your Gleason score means and what you should do about it.

Read more in our Prostate Cancer Health Center.

References

Albertsen PC et al. Prostate cancer and the Will Rogers phenomenon. Journal of the National Cancer Institute 2005; 97:1248–53.

Allsbrook Jr WC et al. The Gleason grading system: an overview. J Urologic Path 19; 10:141–157.

Carter AH et al. Gleason score 6 adenocarcinoma: Should it be labeled as cancer? Journal of Clinical Oncology 2012 Dec 10; 30(35): 4294–96.


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