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The Gleason Grading System

The Gleason grading system was created in 1966 by pathologist Dr. Donald Gleason. He developed his grading system by using information he had gathered from studies of the biopsies of men who had been diagnosed with prostate cancer. The grading system is used in helping not only to assess the prognosis of men with prostate cancer, but also to provide a doctor with enough information in choosing the best treatment option . The Gleason system is utilized by pathologists worldwide and provides a cogent measurement to determine the severity of prostate cancer.

How It Works

A urologist will obtain prostate tissue samples for further analysis by performing a procedure called a biopsy. A biopsy aids in determining whether there are cancerous cells existent in the prostate and gauge the potential aggressiveness of the cancer. The prostate tissue sample is collected by the use of a hollow needle inserted through the rectum. The samples are then given to a pathologist who will examine them thoroughly under a microscope to ascertain exactly where the cancer is the most prominent (the primary grade) and then where it’s next most prominent (the secondary grade). Based on the examination the pathologist will then relegate a score ranging from 1 to 5 for both the primary grade and secondary grade.

Understanding Your Results

If the Gleason score is a 6 or lower, the tumor is in an early stage and the cancer is considered low-risk. This means that the prostate cancer is unlikely to grow or spread to other tissues or organs for many years. Men with low-risk prostate cancer are often monitored with active surveillance and have frequent checkups that may include PSA tests, DREs, ultrasound or other imaging, and repeat prostate biopsies.

If the Gleason score is a 7, the tumor is in between an early stage and an aggressive stage and the cancer is considered moderate-risk. While this means that the prostate cancer is unlikely to grow or spread for many years, the doctor will likely recommend treatment such as surgery or radiation while taking into account the patient’s age and overall health. Treating prostate cancer when the disease is in an early to medium stage gives the most optimal outcome.

If the Gleason score is 8 or higher, the tumor is in a more advanced tumor stage and the cancer is considered high-risk. If the cancer has not spread beyond the prostate, it is still possible to treat it successfully which is usually done with surgery. Radiation may be required after surgery in case any prostate cancer cells may have escaped from the prostate gland due to being in an advanced stage. The doctor will likely recommend immediate treatment because high-risk prostate cancers are likely to grow or spread within a few years.

Dr. David Samadi | Robotic Prostate Surgeon

About is a resource created by Dr. David Samadi in order to raise awareness and get more men to receive prostate cancer treatment. The information is strictly general and you should always discuss with your doctor issues concerning your health.


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