What Is The Gleason Grading System
Your Gleason score isnt a separate test. Its a number based on the results of your biopsy. You usually get it when youre first diagnosed with prostate cancer.
The doctor uses the numbers 1 to 5 to grade the most common and second most common patterns of cells found in a tissue sample:
- Grade 1. The cells look very much like normal prostate cells.
- Grades 2-4. Cells that score lower look closest to normal and represent a less aggressive cancer. Those that score higher look the furthest from normal and will probably grow faster.
- Grade 5. Most cells look very different from normal.
The two grades added together are your Gleason score. Cancers will score 6 or more. A score of 7 means the cancer is intermediate, and a higher score means the cancer is more likely to grow and spread.
Your doctor will use this combined score along with the results of your PSA blood test and digital rectal exam to see how advanced your prostate cancer is. Theyll use this information to suggest the best treatment for you.
What Does It Mean If In Addition To Cancer My Biopsy Report Also Mentions Acute Inflammation Or Chronic Inflammation
Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase your PSA level, but it is not linked to prostate cancer. The finding of prostatitis on a biopsy of someone with prostate cancer does not affect their prognosis or the way the cancer is treated.
What Does It Mean
A Gleason score of 6 is low grade, 7 is intermediate grade, and a score of 8 to 10 is high grade cancer.
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Its also important to know whether any cells rated at Gleason grade 5 are present, even in just a small amount, and most pathologists will report this. Having any Gleason grade 5 in your biopsy or prostate puts you at a higher risk of recurrence.
But because many prostate cancer cases are extremely slow-growing, the Gleason system didnt necessarily do a good job of communicating the risks for these cases. Patients with scores of 6 and 7 didnt have a clear picture of the nature of their particular cancer.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
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I was not drinking water before I started having problems. The only time Id drink water was when Id be really thirsty. That was rarely because I had quite playing sports & other activities that involved exercise. Water is a major player in prostate health & health in general terms. Did you know that water is the most natural cleanser for the body?
You should drink 8-10 glasses a day of water. If youre not getting water or enough water then this should be a change you need to make immediately. I now drink over 10 glasses of purified/bottled water daily. A lot of prostate sufferers are scared to drink more because theyre afraid it will make them go to the bathroom too much. I was there & didnt want to make things worse.
I was wrong in my thinking because drinking more water actually made things much better after a while. At first upon water increase I did see a spike in symptoms but that was part of the cleansing process for a few weeks.
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What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
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What Does It Mean When There Are Different Core Samples With Different Gleason Scores
Cores may be samples from different areas of the same tumor or different tumors in the prostate. Because the grade may vary within the same tumor or between different tumors, different samples taken from your prostate may have different Gleason scores. Typically, the highest Gleason score will be the one used by your doctor for predicting your prognosis and deciding on treatment options.
How Important Is The Gleason Score
The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:
- The blood PSA level
- How much of each core is made up of cancer
- The number of cores that contain cancer
- Whether cancer was found in both sides of the prostate
- Whether the cancer has spread outside the prostate
Gleason Score 7 Adenocarcinoma Of The Prostate With Lymph Node Metastases: Analysis Of 184 Radical Prostatectomy Specimens
Oleksandr N. Kryvenko, Nilesh S. Gupta, Nilam Virani, Daniel Schultz, Juan Gomez, Ali Amin, Zhaoli Lane, Jonathan I. Epstein Gleason Score 7 Adenocarcinoma of the Prostate With Lymph Node Metastases: Analysis of 184 Radical Prostatectomy Specimens. Arch Pathol Lab Med 1 May 2013 137 : 610â617. doi:
Context.âProstate cancer with lymph node metastases is relatively rare, whereas it is relatively common in disease with a Gleason score 8 to 10 and virtually never seen in PC with GS 6 or less. It is most variable in GS 7 PC.
Objective.âTo determine clinicopathologic features associated with GS 7 PC with LN+ compared with a control group without lymph node metastases .
Design.âWe analyzed 184 GS 7 radical prostatectomies with LN+ and the same number of LNâ Gleason-matched controls. The LN+ cases were GS 3 + 4 = 7 , GS 4 + 3 = 7 , GS 3 + 4 = 7 with tertiary 5 , and GS 4 + 3 = 7 with tertiary 5 .
.âGleason score 7 PC with LN+ has features highlighting a more-aggressive phenotype. These features can be assessed as prognostic markers in GS 7 disease on biopsy or at radical prostatectomies , even in men without LN dissection or LNâ disease.
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What Is A Gleason Score
If you have prostate cancer, your Gleason score is one factor healthcare providers consider to develop your treatment plan.
Your score reflects what providers learned about your cancer after examining tissue samples from your prostate cancer biopsy. They looked for patterns of normal and abnormal cells, noting where your cells look more like cancerous cells and where they look more like healthy cells.
Then they graded each piece of the pattern on a 3 to 5 scale. Pattern pieces with cancer cells that look like healthy cells were graded low. Pieces with cancer cells that don’t look like healthy cells get high grades.
Providers add those scores to set an overall Gleason score between 6 and 10. They might refine their analysis by classifying your cells by group, with Gleason scores listed in grade groups 1 to 5.
Prognostic Grouping Of Prostate Cancer
TNM prognostic grouping for prostate cancer is based on the stage, PSA level and Gleason score. This grouping is more accurate in predicting a prognosis than TNM staging alone. It goes without saying that the lower the scores, the best outlook and chance that your cancer can be successfully treated without the cancer coming back .
In contrast, if the prognosis is darker for men with higher scores, there may still be treatment options to control your cancer, improve your quality of life and prolong your survival.
Doctors also use nomograms to predict a prostate cancer prognosis. Nomograms are predictive tools.
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Prostate Cancer Risk Groups
In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.
Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.
If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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Does Percent Gleason Pattern 4 Stratify The Prognosis Of Patients Undergoing Radical Prostatectomy
Table 1 summarizes the findings in previous studies assessing the impact of percent Gleason pattern 4 in prostate needle biopsy, radical prostatectomy, or both on stratifying patient outcomes.
Prior to the recommendation from the ISUP 2014 consensus conference, the relative proportion of high-grade carcinoma in radical prostatectomy specimens was reported to strongly associate with established prognostic factors, such as higher preoperative prostate-specific antigen levels, positive surgical margins, extraprostatic extension, and lymph node metastasis. In a study by Cheng et al. involving 504 men who underwent radical prostatectomy for clinically localized prostate cancer, the rates of 10-year cancer-specific survival were 100%, 85%, and 67% in those with 0% Gleason pattern 4/5, 1â20% Gleason pattern 4/5, and > 20% Gleason pattern 4/5, respectively . Thus, in these 504 patients, the combined percent Gleason patterns 4 and 5 were found to be an independent predictor of cancer-specific survival.
Sauter et al. subsequently assessed a system for integration of both Gleason patterns 4 and 5 into a continuous numerical scale or score . Based on their data from 13,261 prostatectomy specimens and 3,295 matched biopsies, the IQ-Gleason score appeared to represent an efficient approach for combining quantitative Gleason grading and tertiary patterns into a single prognostic variable.
Outlook For Men With Localised Prostate Cancer
Most localised prostate cancer is slow-growing and may not need treatment or shorten a mans life. For many men who have treatment for localised prostate cancer, the treatment will get rid of the cancer. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.
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Percent Gleason Pattern 4 In Stratifying The Prognosis Of Patients With Intermediate
Meenal Sharma1, Hiroshi Miyamoto1,2,3
Department of Pathology and Laboratory Medicine, 2 University of Rochester Medical Center , , USA
Contributions: Conception and design: All authors Administrative support: None Provision of study material or patients: None Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.
Abstract: The Gleason score remains the most reliable prognosticator in men with prostate cancer. One of the recent important modifications in the Gleason grading system recommended from the International Society of Urological Pathology consensus conference is recording the percentage of Gleason pattern 4 in the pathology reports of prostate needle biopsy and radical prostatectomy cases with Gleason score 7 prostatic adenocarcinoma. Limited data have indeed suggested that the percent Gleason pattern 4 contributes to stratifying the prognosis of patients who undergo radical prostatectomy. An additional obvious benefit of reporting percent pattern 4 includes providing critical information for treatment decisions. This review summarizes and discusses available studies assessing the utility of the percentage of Gleason pattern 4 in the management of prostate cancer patients.
Keywords: Gleason grading prognosis prostate biopsy radical prostatectomy
Submitted Dec 12, 2017. Accepted for publication Mar 14, 2018.
What Is Prostate Cancer
Prostate cancer occurs when the cells in the prostate gland begin to grow rapidly and out of control. Usually, it starts out growing slowly and stays within the prostate.
There are 5 types of prostate cancers:
- Transitional cell carcinomas
Chances are high that when you are diagnosed with prostate cancer, it is adenocarcinoma, which starts in the gland cells.
The other 4 types of prostate cancers are less common. Like all cancers, prostate cancer is graded to determine how aggressive and rapidly it is growing. No matter the type of cancer, all patients diagnosed are staged. This means assigning a grade that defines how aggressive the cancer is. For staging prostate cancer, the Gleason Score is the method used.
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New Contemporary Prostate Cancer Grading System
Discrete Well-formed Glands
Copyright 2013 – The Johns Hopkins University. All rights reserved. Jonathan Epstein, M.D.
Gleason Patterns 1-3: from left to right1st Row: Closely packed uniform sized and shaped large glands Large variably sized and shaped glands, some with infolding Uniform medium sized glands Variably sized glands2nd Row: Occasional tangentially sectioned glands amongst well-formed small glands Occasional tangentially sectioned glands amongst well-formed glands with open lumina Back-to-back discrete glands Branching glands
Copyright 2013 – The Johns Hopkins University. All rights reserved. Jonathan Epstein, M.D.
Gleason Pattern 4: from left to right3rd Row: Large irregular cribriform glands with well-formed lumina Irregular cribriform glands with slit-like lumina, glomeruloid structures, and fused glands Irregular cribriform glands with small round lumina Small round cribriform glands4th Row: Poorly-formed glands with peripherally arranged nuclei Small poorly-formed glands Small poorly-formed glands Fused poorly-formed glands
Sheets/Cords/Single Cells/Solid Nests/Necrosis
Copyright 2013 – The Johns Hopkins University. All rights reserved. Jonathan Epstein, M.D.
Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation for patients with prostate cancer include the following:
Cryosurgery, or cryotherapy, is under evaluation for the treatment of localized prostate cancer. It is a surgical technique that involves destruction of prostate cancer cells by intermittent freezing of the prostate with cryoprobes, followed by thawing. There is limited evidence regarding its efficacy and safety compared with standard prostatectomy and radiation therapy, and the technique is evolving in an attempt to reduce local toxicity and normal tissue damage. The quality of evidence on efficacy is low, currently limited to case series of relatively small size, short follow-up, and surrogate outcomes of efficacy.
Serious toxic effects associated with cryosurgery include bladder outlet injury, urinary incontinence, sexual impotence, and rectal injury. Impotence is common, ranging from about 47% to 100%.
The frequency of other side effects and the probability of cancer control at 5 years follow-up have varied among reporting centers, and series are small compared with surgery and radiation therapy. Other major complications include urethral sloughing, urinary fistula or stricture, and bladder neck obstruction.
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer.
Neoadjuvant hormonal therapy
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Correlation Of Percent Pattern 4 Between Needle Biopsy And Radical Prostatectomy Specimens
Correlations between Gleason scores at needle biopsy and corresponding radical prostatectomy remain a major issue, although the modified Gleason grading system has contributed to achieving better concordance. For instance, a study involving 7,643 matched biopsiesâprostatectomies published in 2012 revealed up-grading in 36.3%, 25.8%, and 30.6% of cases with biopsy Gleason scores 5â6, 3+4, and 4+3, and down-grading in 12.0% and 41.1% cases with biopsy with Gleason scores 3+4 and 4+3, respectively . To the best of our knowledge, only a few studies have assessed the concordance between the quantity of Gleason pattern 4 in prostate biopsy and prostatectomy findings.
In one study, a total of 256 biopsy cases with Gleason score 7 cancer divided into five groups, 1â20%, 21â40%, 41â60%, 61â80%, and 81â100%, according to the highest percentage of GP4 in the biopsy were correlated with histopathological findings of matched radical prostatectomy . Up-grading at prostatectomy was observed in 15.9% of biopsy Gleason score 3+4=7 cases and 11.5% of biopsy Gleason score 4+3=7 cases. Higher percentage of Gleason pattern 4 in biopsy was significantly associated with not only higher incidence of Gleason score â¥7 but also larger tumor volume and higher pathologic stage in prostatectomy specimens.