CMedEd > Genitourinary > Risk Assessment and Gleason Grading System for Prostate Cancer

Risk Assessment and Gleason Grading System for Prostate Cancer

Print

Risk Assessment

If you are diagnosed with prostate cancer, your physician will attempt to determine the risk that your disease will be harmful to you in the future. In order to estimate the risk, your physician will take into account your PSA level, clinical stage based on your digital rectal exam and your Gleason score, which is explained below. The levels of risk-low, intermediate and high- are explained below:

Low Risk
  • Less than 10% chance of having spread to other areas of the body
  • Low risk of growth or spread if not treated
  • PSA less than 10 ng/nL
  • Gleason score of less than 6
  • No tumor felt on DRE or feels contained within the prostate with only a small abnormal area
Intermediate Risk
  • 10% to 15% chance of spreading
  • High chance (up to 70% over 15 years) of growth and spread if not treated
  • PSA of 10 to 20 ng/mL
  • Gleason score of 7
  • Tumor can be felt on one or both sides on DRE, but likely to be contained
High Risk
  • Aggressive features that increase the likelihood of spreading now or in the future
  • PSA over 20 ng/mL
  • Gleason score of 8 to 10
  • Tumor can be felt on DRE and seems to have progressed outside the gland

Gleason Grading System

If your biopsy is positive, it will be classified using the Gleason grading system. This will assist doctors in choosing the best treatment options and predicting how quickly the cancer is growing.

Prostate cancer contains several types of cells. The Gleason system uses the numbers 1 to 5 to grade the most common (primary) and next most common (secondary) cell types found in the biopsy sample. The sum of these two numbers is the Gleason score, which tells you how aggressive the tumor is. The higher the Gleason score, the more aggressive the cancer.

Gleason grades 1 and 2 are rarely seen since these changes are now usually classified as benign or are located at the center of the gland and remain undiscovered. That means the usual lowest grade is 3. Gleason scores of:

  • 3+3 are low grade and have the lowest risk of harm. 6 would be your Gleason Score.
  • 3+4 and 4+3 are intermediate risk — the latter being the more aggressive type. 7 would be your Gleason Score.
  • 4+4 through 5+5 are the highest risk. 8 or 10 would be your Gleason Score.

If the prostate cancer is determined to be intermediate or high risk, imaging tests such as bone scans and CAT or MRI scans may be ordered to determine if the cancer has spread.

Altogether, the disease risk status and imaging results will help your doctor plan the best treatment.

Disclaimer - The contents of CMedEd.Com are for informational purposes only and are not a replacement for professional medical advice. Always consult your physician about any medical concerns or conditions. CMedEd.Com does not endorse any specific tests, procedures, physicians, or other information mentioned on the website.