The Gleason Scale

The Gleason scale grading system is used to help evaluate the prognosis of men with prostate cancer using samples from a prostate biopsy. The Gleason Scale is the grading system used to determine the aggressiveness of prostate cancer. The resulting diagnosis will indicate how serious the cancer is, helping to determine appropriate treatment options.
Gleason worked out that prostate cancerous cells fall into five different patterns, as they change from normal cells to tumorous cells. Cells that score a 1 are considered to be very low-grade tumour cells and least aggressive, while 5 was the most aggressive cells.
Gleason noticed that many men had more than one cell type so he assigned every cancer biopsy two numbers;

  • the first number (1-5) represented the most common type of prostate cancer cell
  • second number (1-5) represented the second most common type of prostate cancer cell

 

GLEASON'S PATTERN SHOWING INCREASING PRESENCE OF CANCER CELLS FROM TOP TO BOTTOM
GLEASON'S PATTERN SHOWING INCREASING PRESENCE OF CANCER CELLS FROM TOP TO BOTTOM (IMAGE FROM NATIONAL INSTITUTE OF HEALTH)

He then added those numbers together to get his score or Gleason Score.
So a Gleason score of 7 may indicate two different options
Score 3+4=7.  This result has a good outlook with no treatment necessary but monitoring the cancer closely would be recommended, known as active surveillance.
A Gleason score 4+3=7. This result indicates that the tumour is more likely to grow and spread but not as likely as a Gleason score 8 tumour. The higher the Gleason score the more serious the cancer. Generally, scores below 6 are considered low grade.

The Gleason score is very important in predicting the severity of prostate cancer and determining the best treatment options. Other factors are also important, such as;

  • The blood PSA level
  • Findings on rectal exam
  • Findings on imaging tests
  • 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

A little over a week after my biopsy, I met with my Consultant Urologist again to get my diagnosis. I had Gleason Scores of 6 and 7 (4+3) and the cancer was present on both sides of the prostate. My diagnosis indicated I had stage 1 prostate cancer.
Giving consideration to the fact that;

  • Family history - an uncle had died from cancer and two of my brothers had already been diagnosed and treated for prostate cancer
  • MRI indicated that it was more extensive than the biopsy tests indicated
  • The fact that I was very much aware that my prostate was impacting my urine flow
  • My PSAs were continuing to rise
  • That if my cancer spread outside the prostate I may not be able to have the treatment of choice and would likely have to resort to radiation
  • The pathology indicated the cancer wasn’t localised

I decided I would go ahead with treatment rather than opting for active surveillance. The treatment I choose was a robotic radical prostatectomy using the DaVinci robot. The procedure was carried out on May 4, 2016. After my surgery my prostate was sent to Pathology for testing and was found to be 30% malignant.

 

 

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