What is the Gleason scoring (Gleason grading system) of prostate cancer?

From the Guidelines

The Gleason scoring system for prostate cancer is determined by adding the grades of the two most common histologic patterns seen in each biopsy core, with scores ranging from 2 to 10, and a higher score indicating more aggressive cancer cells. The Gleason score is calculated by assigning a primary grade for the most prevalent pattern and a secondary grade for the next most common pattern, with each pattern scored from 1 to 5, and the most common grade being 6 1.

Key Points to Consider

• The Gleason score helps determine the prognosis of prostate cancer, with scores of 6 indicating low-grade cancer, scores of 7 suggesting intermediate-risk cancer, and scores of 8-10 representing high-grade, aggressive cancer 1.
• A grade 7 cancer is more aggressive if its scoring is 4+3 instead of 3+4, highlighting the importance of considering the primary and secondary grades 1.
• The system has been refined into the Grade Group system, which categorizes scores into five groups: Grade Group 1 (Gleeson 6), Grade Group 2 (Gleeson 3+4=7), Grade Group 3 (Gleeson 4+3=7), Grade Group 4 (Gleeson 8), and Grade Group 5 (Gleeson 9-10) 1.

Clinical Implications

• The Gleason scoring system is crucial for treatment planning, helping physicians determine whether active surveillance, surgery, radiation, or other therapies are most appropriate for each patient 1.
• Accurate Gleason scoring is essential for ensuring the best possible outcomes for patients with prostate cancer, as it directly impacts treatment decisions and prognosis 1.

From the Research

Overview of Gleason Scoring

The Gleason scoring system is a method used to grade prostate cancer based on the histologic pattern of arrangement of carcinoma cells in H&E-stained sections 2, 3. The system assigns a score ranging from 2 to 10, with higher scores indicating a more aggressive form of cancer.

Gleason Grading System

The Gleason grading system is based on five basic grade patterns, which are used to generate a histologic score 3. The system has undergone several modifications since its inception, with the most recent modifications being made by the International Society of Urological Pathology (ISUP) in 2005 and 2014 4, 5.

Prognostic Gleason Grade Grouping

Studies have shown that the Gleason scoring system can be divided into prognostically accurate Gleason grade groups, which can help predict patient outcomes 6. The proposed prognostic grade groups are:

• Gleason score ≤ 6 (prognostic grade group I)
• Gleason score 3+4=7 (prognostic grade group II)
• Gleason score 4+3=7 (prognostic grade group III)
• Gleason score 8 (prognostic grade group IV)
• Gleason score 9-10 (prognostic grade group V)

Key Features of the Gleason Scoring System

Some key features of the Gleason scoring system include:

• The system is based on the histologic pattern of arrangement of carcinoma cells in H&E-stained sections 3
• The system assigns a score ranging from 2 to 10, with higher scores indicating a more aggressive form of cancer 2
• The system has undergone several modifications since its inception, with the most recent modifications being made by the ISUP in 2005 and 2014 4, 5
• The system can be divided into prognostically accurate Gleason grade groups, which can help predict patient outcomes 6

Clinical Implications

The Gleason scoring system has significant clinical implications, including:

• Predicting patient outcomes and guiding treatment decisions 2, 6
• Facilitating patient communication and understanding of their diagnosis 5
• Providing a framework for comparing data and outcomes across different studies and treatment modalities 2, 4