Gleason Score Breakdown: Numbers, Risks, and What to Expect

When it comes to understanding prostate cancer, one of the most crucial tools is the Gleason Score. This score helps doctors determine how aggressive the cancer is, guiding treatment options and helping predict outcomes. If you or a loved one has been diagnosed with prostate cancer, knowing how the Gleason Score works and what each score range means can help you make informed decisions.

What is the Gleason Score?

The Gleason Score is a system used by doctors to grade prostate cancer based on how abnormal the cancer cells look under a microscope. Developed by Dr. Donald Gleason in the 1960s, this scoring system assigns a number between 6 and 10 to indicate the aggressiveness of the cancer:

• Lower scores (6) indicate less aggressive, slower-growing cancer.
• Higher scores (10) indicate more aggressive, faster-growing cancer.

How is the Gleason Score Calculated?

The score is calculated by examining two areas of the prostate tumor under a microscope and assigning each area a grade from 1 to 5:

• Grades 1-2: Cells look almost like normal prostate cells (least aggressive).
• Grade 3: Cells are moderately abnormal.
• Grades 4-5: Cells are very abnormal (most aggressive).

The grades of the two most common types of cells are then added together to form the Gleason Score. For example:

• If the two most common grades are 3 and 4, the Gleason Score would be 3 + 4 = 7.
• If the grades are 4 and 5, the score would be 4 + 5 = 9.

Breaking Down Gleason Score Ranges

The Gleason Score is usually divided into three main categories, each with different levels of risk and treatment approaches:

1. Gleason Score 6 (Low Risk)
   • Score: 3 + 3 = 6
   • Description: Low-risk cancer. Cells look more like normal prostate cells, and the cancer is likely to grow slowly.
   • Treatment Approach: Many men with a Gleason Score of 6 might not need immediate treatment. Instead, doctors may recommend active surveillance—closely monitoring the cancer without active treatment unless it shows signs of growth. This is often suitable for men with low-risk, localized prostate cancer.
   Example: Mark, a 55-year-old with a Gleason Score of 6, might be advised to get regular PSA tests and biopsies every few months rather than immediate surgery or radiation.
2. Gleason Score 7 (Intermediate Risk)
   • Score: 3 + 4 = 7 or 4 + 3 = 7
   • Description: Moderate-risk cancer. The score of 7 can be broken down into two subtypes:
     • 3 + 4 = 7: Slightly less aggressive; more normal-looking cells.
     • 4 + 3 = 7: Slightly more aggressive due to a higher number of abnormal cells.
   • Treatment Approach: Intermediate-risk cancer often requires active treatment. Depending on the patient’s age, health, and preferences, doctors may suggest surgery, radiation therapy, or sometimes hormone therapy.
   Example: John, a 62-year-old with a 4 + 3 Gleason Score, may choose to undergo surgery to remove the prostate gland. His doctor explains that since his cancer is moderately aggressive, waiting could increase the risk of spread.
3. Gleason Score 8-10 (High Risk)
   • Score: 4 + 4 = 8, 4 + 5 = 9, or 5 + 5 = 10
   • Description: High-risk cancer. These scores indicate that the cancer cells look very different from normal cells and are more likely to grow quickly and spread.
   • Treatment Approach: High-risk cancers require more intensive treatment. Doctors may suggest a combination of therapies, such as surgery, radiation therapy, hormone therapy, or even chemotherapy to target the cancer aggressively. In some cases, clinical trials for newer treatments may be an option.
   Example: Alex, a 70-year-old with a Gleason Score of 9, discusses with his doctor the possibility of undergoing a combination of radiation and hormone therapy. Due to the high risk associated with his score, aggressive treatment is recommended to control the spread.

What to Expect Based on Your Gleason Score

The Gleason Score plays a big role in determining a prostate cancer treatment plan, but it’s not the only factor. Doctors also consider other aspects, like PSA levels, age, overall health, and whether the cancer has spread beyond the prostate. Here’s a summary of what to expect based on your Gleason Score category:

• Gleason 6 (Low Risk): Likely to follow active surveillance with regular check-ups. The chance of cancer spreading quickly is low.
• Gleason 7 (Intermediate Risk): Often treated with surgery, radiation, or hormone therapy. This score indicates moderate aggressiveness, so a watchful waiting approach may not be recommended.
• Gleason 8-10 (High Risk): Requires immediate, often multi-step treatment due to high aggressiveness. Regular monitoring and post-treatment follow-up are crucial.

How the Gleason Score Impacts Prognosis

While no one can predict exactly how prostate cancer will behave, the Gleason Score offers valuable clues:

• Lower Scores (6) are generally associated with a very good prognosis, especially with regular monitoring.
• Intermediate Scores (7) can vary, with 3 + 4 usually having a better outlook than 4 + 3.
• High Scores (8-10) are more serious and require aggressive treatment. However, with advances in treatment, many men with high scores manage the disease well.

Final Thoughts: Working with Your Healthcare Team

The Gleason Score is a powerful tool to help you and your doctor decide the best course of action. If you’re diagnosed with prostate cancer, talk openly with your doctor about your Gleason Score and other factors that might impact your treatment options. By understanding this scoring system, you can make choices that align with your goals and give you the best possible outlook. Remember, you don’t have to face this alone—your healthcare team is there to guide and support you every step of the way.