Trying to understand the logic of Gleason scores

Hi yaamba,

In answer to your question the answer is that the Gleason Score or GS =
two numbers representing:
a) the predominant pattern and
b) the next most predominant pattern seen by the pathologist when examining prostate cancer tissue.

So if you have a 12 core biopsy and 50% of one core is 5+4 and a further eight cores have 50% of 3+3, then your Gleason score would be 3+5. Gleason 3 would be the most predominant and one core had more Gleason 5 than Gleason 4 so Gleason 5 would be the next most predominant.

However important thing to note here is that the Gleason score is only one indicator of the seriousness of the cancer. A high total number or cores with cancer and the total percentage of the cores indicate a high volume tumor which can be dangerous. In addition to this a Gleason 3+4 with presence of tertiary Gleason 5 is a lot more dangerous than a straight 3+4 without the 5.

Hope this helps.

I hope the HDR Brachytherapy goes well and good luck to your husband. There have been many here who have done very well with ths treatment and I hope your husband will be among them.

In regards to your concerns about the hormone therapy, a blood test showing psa levels and testosterone levels should put both of your minds at ease. And if it's not working then they will know what's happening and change his dose. Is this nt happening?

I wish you both the best for the 1st of may.

An

In offering a supplement to An’s very good explanation of Gleason scoring, I hope that this post adds clarity, further detail, and greater understanding… there is, I believe, an important “fine point” which appears to be left out of An's repsonse which directly addresses the original question.   As background information, keep in mind that a unique Gleason score is assigned to each and every biopsy core sample.   And also keep in mind that most biopsy procedures include multiple core samples, with 12 or 18 cores being typical.   These facts are, I believe, already widely understood. What may not be so widely understood, and may not be clear from An’s descript ion , is how a single, overall Gleason score is reported by treating physicians.   For completeness , the typical report from the pathologist will provide results for each and every core sample, reporting both Gleason score (and also percent of cancer) for each sample in which cancer was found.   However, for brevity in reporting Gleason score, treating doctors will typically personalize the patient’s risk based on a single , overall Gleason score known as the worst Gleason score (WGS).   As a simplified example of how the WGS is used, in a pathology report indicating a total of only 4 cores positive, with 3 cores 3+3 and 1 core 3+4, the overall result is reported as the worst Gleason score (3+4). The WGS reporting methodology is endorsed by the International Society of Urological Pathologists, and also referenced in this document of the American Urological Association:   AUA Guideline   I hope that this adds clarity…I do realize it is a "fine point" which may not be of interest/concern to everyone...      There is, in fact, another refinement to An’s descript ion which I will capture here, although it may or may not be relevant to the original poster’s question. In an example of a prostate biopsy sample demonstrating primary Gleason pattern 3, and secondary pattern 4, and tertiary pattern 5, this case is graded 3+5 even though the 5 pattern was tertiary in order to indicate the significance of the higher (5) pattern.   This method of reporting represents a change in practice by the ISUP from their 2005 conference; in the past, the example given here would have been reported 3+4 and tertiary results may or may not have been additionally reported. This additional point may be of interest, perhaps, to some; perhaps of no interest to others…perhaps only for dinner party trivia/small talk.     edit:   added clarity in wording Post Edited (Casey59) : 4/4/2012 2:27:00 PM (GMT-6)