Gleason score

Gleason score

A Gleason score is given to prostate cancer based upon its microscopic appearance. Cancers with a higher Gleason score are more aggressive and have a worse prognosis.

Most often, a urologist will remove a cylindrical sample (biopsy) of prostate tissue through the rectum, using hollow needles, and prepare microscope slides. After a prostate is removed in surgery, a pathologist will slice the prostate for a final examination.

The pathologist assigns a "grade" to the most common tumor, and a second "grade" to the next most common tumor. The two "grades" are added together to get a Gleason "score". For example, if the most common tumor was grade 3, and the next most common tumor was grade 4, the Gleason "score" would be 3+4 = 7.

The Gleason grade is also known as the Gleason pattern and the Gleason score is also known as the Gleason sum.

In the UK, prostate cancer of Gleason pattern 1 and 2 are almost never seen. Gleason pattern 3 is by far the most common.

The Gleason "grade" ranges from 1 to 5, with 5 having the worst prognosis. The Gleason "score" ranges from 2 to 10, with 10 having the worst prognosis.

It should be noted that for Gleason score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4. Also, there is not really any difference between the aggressiveness of a Gleason score 9 or 10 tumour.

Gleason scores are associated with the following features:

* Grade 1 - The cancerous prostate closely resembles normal prostate tissue. The glands are small, well-formed, and closely packed
* Grade 2 - The tissue still has well-formed glands, but they are larger and have more tissue between them.
* Grade 3 - The tissue still has recognizable glands, but the cells are darker. At high magnification, some of these cells have left the glands and are beginning to invade the surrounding tissue.
* Grade 4 - The tissue has few recognizable glands. Many cells are invading the surrounding tissue
* Grade 5 - The tissue does not have recognizable glands. There are often just sheets of cells throughout the surrounding tissue.

A pathologist examines the biopsy specimen and attempts to give a score to the two patterns. First called the primary grade, represents the majority of tumor (has to be greater than 50% of the total pattern seen). Second - a secondary grade - relates to the minority of the tumor (has to be less than 50%, but at least 5%, of the pattern of the total cancer observed). These scores are then added to obtain the final Gleason score.

Increasingly, pathologists provide details of the "tertiary" component. This is where there is a small component of a third (generally more aggressive) pattern. So there could be a Gleason 3+4 with a tertiary component of pattern 5 - this would be considered to be more aggressive than a prostate cancer that was Gleason 3+4 with no tertiary pattern 5. Although it is debateable as to what the full extent the tertiary component has on the aggressiveness of a cancer.

The Gleason score is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, the Gleason score is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy.

The scoring system is named after Donald F. Gleason, M.D., a pathologist at the Minneapolis Veterans Affairs Hospital who developed it with other colleagues at that facility in the 1960s. [ [http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=325501 Manage Account - Modern Medicine ] ] It remains an important tool.

References

* [http://www.medscape.com/viewarticle/406837 Minimal Adenocarcinoma in Prostate Needle Biopsy Tissue,] Phataraporn Thorson, MD, and Peter A. Humphrey, MD, PhD, Am J Clin Pathol 114(6):896-909, 2000. Pathology slides and explanation. [Free]

* [http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=13&cat3=749&stype=d WHO, Geneva Foundation for Medical Education and Research, Prostate cancer, Gleason score.] 51 images.

*Gleason DF. "The Veteran's Administration Cooperative Urologic Research Group: histologic grading and clinical staging of prostatic carcinoma." In Tannenbaum M (ed.) Urologic Pathology: The Prostate. Lea and Febiger, Philadelphia, 1977; 171-198.

* [http://www.malecare.com Prostate Cancer Information website, nonprofit, updated weekly]


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