Prostate Cancer Gleason Score
Assesses stage and prognosis of prostate neoplasm based on biopsy findings.
In the text below the calculator there is more information about the score and about prognosis in prostate cancer.
The Gleason score is the most used prostate neoplasm staging system. It is based on the primary and secondary grade sample tissue biopsy results.
The result offers guidance regarding how advanced the cancer is and about prognosis.
The Gleason score depends on the primary and secondary cancer grade and varies in practice between 6 and 10.
Scores below 7 indicate a favourable prognosis with cancer likely to react to treatment whilst scores greater than 7 have a less favourable prognosis.
It is important to note that the same score can have two different meanings, for example scores of 7 can be obtained as:
■ (3+4) where the majority of cells in the sample exhibit a slow growth (more favourable prognosis);
■ (4+3) where most of the cells exhibit a moderate growth.
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The Gleason scoring system explained
The Gleason score is a scale that helps with the staging of prostate cancer (by aggressiveness and prognosis) based on the microscopic examination of the sample tissue in the prostate biopsy.
The grades in the score compare the pattern of the cancerous tissue with that of normal tissue in regard to aspects including:
■ Shape;
■ Disposition;
■ Spread.
There are two grades that are awarded, each on a scale from 1 to 5:
■ The primary grade is given to the most commonly observed type of cell;
■ The secondary grade is given to the second most common type of cancerous cell.
The following table summarises the five grades, in terms of cell resemblance, glandular tissue presence and aspect and type of carcinoma:
| Gleason grade | Cancerous cells | Glandular tissue | Carcinoma |
| 1 | Resemble normal prostate cells | Small and packed together | Well differentiated |
| 2 | Some cells resemble normal prostate cells, others don’t | Well formed but presents larger cells with more tissue between suggesting an increase in stroma | Moderately differentiated |
| 3 | Some cells resemble normal prostate cells, others don’t | Still present with cells leaving it and invading the surrounding tissue | Moderately differentiated - some biopsy samples present an infiltrative pattern |
| 4 | Some cells appear similar to normal prostate ones, others don’t | Less recognizable glandular tissue as the cells are invading the surrounding tissue | Poorly differentiated |
| 5 | Cancerous tissue cells have an abnormal look and appear scattered throughout the tissue | Little prostate gland left as the cells have invaded all the surrounding tissue | Anaplastic carcinoma |
Result interpretation
The total Gleason score is formed by summing the primary and the secondary grade and the results vary in theory between 2 and 10. In practice, pathologists use grades from 6 to 10 to describe cancers from biopsy tissue.
A higher score indicates a cancer that is growing and is more likely to spread than a lower score one.
The higher the score, the greater the evolution of the cancer, the greater its aggressiveness and the worse the prognosis.
The following table introduces the Gleason scores met in practice and their descriptions:
| Gleason score | Description |
| 6 (3+3) | All cancer cells from the sample are representative for grade 3 and exhibit a slow growth. |
| 7 (3+4) | The majority of cancer cells in the biopsy tissue exhibit a slow growth but there are also cells that have a moderate growth. |
| 7 (4+3) | The majority of cancer cells in the sample exhibit a moderate growth and are invading the surrounding tissue but there are cells appearing to grow slower. |
| 8 (4+4) | All cancer cells found in the sample are grade 4 with a moderate rate of growth and are starting to invade the surrounding tissue. |
| 9 (4+5) | Most of the cancer cells in the sample appear to grow moderately fast while there are also present cells with a more rapid growth. |
| 9 (5+4) | The majority of cancer cells in the biopsy tissue appear scattered and are invading surrounding tissue. They grow at a more rapid rate than the other cells in the sample. |
| 10 (5+5) | All the cancerous cells found in the sample exhibit a high rate of growth. There is less glandular tissue than normal. |
According to the above, a score of 7 can be obtained in two different situations:
■ (4+3) where the cancer is more aggressive as there is more grade 4 tissue (moderate growth);
■ (3+4) where the cancer is less aggressive as it contains more grade 3 tissue (slow growth).
Most common scores in diagnosis are 6 with well differentiated cells and 7 with moderately differentiated cells.
Prostate cancer prognosis
Prognosis and survival in prostate neoplasm depend on different individual factors such as patient age, stage the cancer is or resistance to therapy.
The majority of prostate cancers are adenocarcinomas that generally respond well to treatment. The rest include sarcomas, small cell carcinomas and transitional cell carcinomas, where the prognosis is less positive.
The prostate cancer stage plays an important role in prognosis, where the less advanced the cancer is at diagnosis, the more favourable the prognosis.
Tumours in stages T1 and T2 (confined to prostate) have a better outcome than tumours in stages T3 and T4 (already spread outside prostate).
In terms of the Gleason score, results lower than 7 are suggestive of a favourable prognosis whilst scores greater than 7 indicate a less favourable prognosis. Scores of 9 or 10 specifically indicate a high grade neoplasm with poorly differentiated or undifferentiated cancer cells.
Based on the data in the Johns Hopkins Radical Prostatectomy Database (1982-2011) of Gleason grades and prognostics, this is the association between the scores and gradings:
| Gleason score | Cancer grading |
| ≤6 | I |
| 7 (3+4) | II |
| 7 (4+3) | III |
| 8 | IV |
| 9 | V |
| 10 | V |
Original source
Gleason, D. F. (1977). "The Veteran's Administration Cooperative Urologic Research Group: histologic grading and clinical staging of prostatic carcinoma". In Tannenbaum, M. Urologic Pathology: The Prostate. Philadelphia: Lea and Febiger. pp. 171–198. ISBN 0-8121-0546-X.
Other references
1. Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL; ISUP Grading Committee. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005; 29(9):1228-42.
2. Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int. 2013; 111(5): 753–760.
Specialty: Urology
System: Urinary
Objective: Evaluation
Type: Score
No. Of Criteria: 3
Year Of Study: 1977
Article By: Denise Nedea
Published On: June 16, 2017 · 07:05 AM
Last Checked: June 16, 2017
Next Review: June 16, 2023