What is prostate cancer grading?

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The grade given to a person diagnosed with prostate cancer determines the potential for the cancer to spread to other parts of the body (metastasize). It is determined when a biopsy of the prostate is looked at under a microscope. The key indicator is how similar the cancer cells are to normal prostate tissue. Cancer cells that are very similar to normal prostate tissue (i.e. arranged in the normal glandular architecture) are given a low Gleason score, those that are poorly differentiated and are more noticeably abnormal are given a high Gleason score. The doctor looks for two separate sections to classify, and the scores are added to give the overall Gleason score.

The lowest possible Gleason score is 2 (1 + 1), where both the primary and secondary patterns have a Gleason grade of 1 and therefore when added together their combined sum is 2.
Very typical Gleason scores might be 5 (2 + 3), where the primary pattern has a Gleason grade of 2 and the secondary pattern has a grade of 3, or 6 (3 + 3), a pure pattern.
Another typical Gleason score might be 7 (4 + 3), where the primary pattern has a Gleason grade of 4 and the secondary pattern has a grade of 3.
Finally, the highest possible Gleason score is 10 (5 + 5), when the primary and secondary patterns both have the most disordered Gleason grades of 5.
The grade of a prostate cancer specimen is very valuable to doctors in helping them to understand how a particular case of prostate cancer can be treated. In general, the time for which a patient is likely to survive following a diagnosis of prostate cancer is related to the Gleason score. The lower the Gleason score, the better the patient is likely to do.

However, remember that prostate cancer is a very complicated disease. People with low Gleason scores have been known to fare poorly and men with high Gleason scores have been known to do well. General principles do not always apply to individual patients.