What clinical stage corresponds to a prostate cancer with a Gleason score of 3 + 4 = 7?

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Clinical Staging of Gleason 3 + 4 = 7 Prostate Cancer

A Gleason score of 3 + 4 = 7 corresponds to Grade Group 2 and is classified as intermediate-risk prostate cancer. 1, 2

Understanding the Grade Group Classification

  • Gleason 3 + 4 = 7 is designated as Grade Group 2, defined by predominantly well-formed glands with a lesser component of poorly formed, fused, or cribriform glands. 3
  • This classification was introduced by the International Society of Urological Pathology and is now recommended by the World Health Organization to be used alongside traditional Gleason scoring. 4
  • The distinction between 3 + 4 and 4 + 3 is critical for prognosis: Gleason 3 + 4 = 7 (Grade Group 2) has significantly better outcomes than Gleason 4 + 3 = 7 (Grade Group 3), with a three-fold difference in lethal prostate cancer risk. 5

Risk Stratification: Favorable vs. Unfavorable Intermediate-Risk

Gleason 3 + 4 = 7 falls within the intermediate-risk category, but must be further subdivided: 2

Favorable intermediate-risk requires ALL of the following:

  • Primary Gleason pattern 3 (i.e., 3 + 4, not 4 + 3) 2
  • Less than 50% of biopsy cores contain cancer 2
  • Only one intermediate-risk factor present (either PSA 10–20 ng/mL or clinical stage T2b-c, but not both) 2

Unfavorable intermediate-risk is defined by ANY of:

  • 50% or more of cores positive 2
  • Multiple intermediate-risk factors (elevated PSA and advanced T stage) 2
  • Primary Gleason pattern 4 (i.e., 4 + 3 = 7) 2

Prognostic Implications

  • Gleason 3 + 4 = 7 disease carries an excellent long-term prognosis, with 10-year prostate cancer-specific survival exceeding 92%. 2
  • After radical prostatectomy in favorable intermediate-risk patients, the 5-year biochemical recurrence-free survival rate is approximately 88%. 2, 3
  • The hazard ratio for biochemical recurrence is 1.9 times that of Gleason score 6 disease, compared to 5.1 for Gleason 4 + 3 = 7. 6

Clinical Stage Integration

The Gleason score alone does not define clinical stage—it must be integrated with:

  • PSA level: Intermediate risk includes PSA 10–20 ng/mL 1, 3
  • Clinical stage: T1c–T2b for intermediate risk 1, 3
  • Number and percentage of positive biopsy cores 2, 3

Common Pitfalls to Avoid

  • Do not equate 3 + 4 with 4 + 3: These have distinctly different prognoses and treatment implications. 5
  • Do not rely on Gleason score alone: Risk stratification requires PSA, clinical stage, and tumor burden assessment. 1, 2
  • Do not overlook the proportion of grade 4 disease: The modified Gleason score (percentage of grades 4 and 5) provides additional prognostic information and should be documented. 7, 1
  • Ensure proper pathology reporting: The report must specify the length of tumor involvement, number of positive cores, presence of extraprostatic extension, and the modified Gleason score. 7, 3

References

1
Guideline

Gleason Score and Prostate Cancer Aggressiveness

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Prognosis and Management of Gleason 3 + 4 = 7 (Grade Group 2) Prostate Cancer

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Prostate Cancer Risk Assessment Based on Gleason Score

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

5
Research

Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3?

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009

7
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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