The Gleason Score is very important in predicting the behavior of a prostate cancer.  Still, other factors are also important such as:

  • The PSA Level
  • Findings on a rectal exam
  • 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

The lowest Gleason Score of a cancer found on a prostate biopsy is 6. These cancers may be called well-differentiated or low-grade and are likely to be less aggressive - they tend to grow and spread slowly. 

Cancers with Gleason Scores of 8 to 10 may be called poorly differentiated or high grade.  These cancers tend to be aggressive, meaning they are likely to grow and spread more quickly.

Cancers with a Gleason Score of 7 may be called moderately differentiated or intermediate grade.  The rate at which they grow and spread tends to be in between the other 2.

Other ways that this Gleason Score may be listed in your report are Gleason 7/10, Gleason 7 (3+4) or combined Gleason Grade of 7. 

Cores may be samples from different areas of the same tumor or different tumors in the prostate. Because the grade may vary within the same tumor or between different tumors, different samples (cores) taken from your prostate may have different Gleason Scores. Typically, the highest (largest number) Gleason Score will be the one used by your doctor for predicting your prognosis and deciding treatment. 

Prostate biopsies are tissue samples from different areas of the prostate.  The Gleason Score on a biopsy usually reflects the cancer's true grade.  However, it is possible that the Gleason Score from your biopsy is lower or higher than the true grade.  To reduce the risk of over-or-under scoring, multiple biopsies are usually taken from different areas within the prostate.

Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber with the prostate. When this is found on a biopsy, it means there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion does not mean that the cancer has spread, and other factors, such as the Gleason Score and amount of cancer in the cores are more important. In some cases, findings perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor. 

High-grade prostatic intraepithelial neoplasia (or high-grade PIN) is a pre-cancer to the prostate.  In this instance, high-grade refers to the PIN and not the Gleason Score.

All of these terms mean the pathologist saw something in your biopsy that suggests cancer may be present, but they cannot be certain.  For individuals with known prostate cancer this is no longer relevant.

Inflammation of the prostate is called prostatitis.  Most cases of prostatitis reported on a biopsy are not caused by infection and do not need to be treated.  In some cases, inflammation may increase you PSA level, but it is not linked to prostate cancer.  The finding of prostatitis on a biopsy of someone with cancer does not affect their prognosis or the way the cancer is treated.

-www.cancer.org

Prostate cancer is a disease that is most successfully treated when it is detected early on.  As the research community explores various methods to detecting the disease, PCEC continues to encourage men to play an active role in their health by looking to those trusted sources of prostate cancer testing – the PSA and DRE.

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