When diagnosed I was told that I had a Gleason score of 7, calculated by adding the first number, a descriptor of the most prevalent cancer cells in the biopsy sample, to the second number, a descriptor for the second most prevalent cancer cells. In my case the actual Gleason score was 4+3 or a 7. It would also have been possible to have had a 7, but instead calculated by a 3+4.
As the cells become more differentiated (or more aggressive and progressed) the assigned Gleason number increases, so a 4 reflects a more advanced and aggressive disease pattern than a 3. So, Is there a difference between a 7 calculated from a 4+3 from a 7 calculated from a 3+4? The answer is YES, there is a difference, an important difference.
The Gleason score is an central prognostic tool for clinicians when deciding what treatments are appropriate. Studies have shown that short-term outcomes for prostate cancer differ according to Gleason scores. Now, researchers at Brigham and Women’s Hospital (BWH), in Boston Ma, have shown that Gleason score is a strong predictor of prostate cancer mortality and that mortality rates differ among patients with a Gleason score of seven depending on whether Gleason pattern four is primary or secondary. This research is published in the May 11 issue of Journal of Clinical Oncology.
Tissue samples from prostatectomies and biopsies from men who were diagnosed with prostate cancer between 1984 and 2004 and were enrolled in the Physicians’ Health Study and Health Professionals Follow-up Study. The samples were then assigned primary and secondary Gleason patterns by pathologists. Researchers found that within the group of men with Gleason scores of seven, men with primary and secondary patterns of 4 and 3 respectively had worse long-term outcomes compared to men with a primary pattern of 3 and secondary pattern of 4.
“Four plus three cancers were associated with a three-fold increase in lethal prostate cancer compared to three plus four cancers,” said Jennifer Rider Stark, Post-doctoral research fellow at BWH and the Harvard School of Public Health. “If we are lumping these cancers into one category of Gleason score 7, then we are missing important prognostic information.”
For the purposes of this study lethal prostate cancer was defined by the development of bony metastases or prostate cancer death. Current clinical practice evaluates and treats men with three plus four cancer differently than a man with four plus three cancer, but until now there was no long-term mortality data to support this practice. Clinicians were making these decisions based primarily on surrogate outcomes such as prostate-specific antigen relapse.
“This study provides clinicians with further evidence that men who have Gleason scores of seven should be evaluated based on the predominant Gleason pattern,” Stark said.
This research was funded by grants from the National Cancer Institute.
So pay attention to how your Gleason score is devised. Men with Gleason 7 scores must be aware that all “7’s” are not the same. If your first number is a 4 your risk for developing bone metastases and dieing from your cancer is significantly higher then those with Gleason “7’s” where the first number is a 3.
Joel T Nowak MA, MSW
Thank you for the best – and most enlightened – explanation as to the intricacies of the Gleason Score, that I have yet to come across.
I have a score of 9 (4 + 5)having been diagnosed some three years ago and so have a particular interest, but have never fully understood it. I do now… thanks.
I have taken the liberty of referencing your blog and article on my own blog and will give you a link on my site. I hope that’s permissible.
I am flattered that you have referenced this blog in your blog and thank you for the link.
David, tell us about your blog and how we can read it.
Thanks for the explanation. I have a 4+3 and must now make a decision regarding surgery or radiation. Any indications of the best route with the more aggressive cancer?
As the article indicated a gleason grade of 4+3 is more aggressive than a score of 3+4. I am of the personal opinion the a 4+3 should be treated, in other words, I would nor recommend active surveillance.
What treatment is best is never clear. You need to factor in things such as your age, general health, PSA score, results of any scans if you have had any and your attitude towards surgery and radiation.
I always suggest that a man should join a support group to meet other individuals who have had different types of treatments. Learn about the treatments and the potential side effects, but remember that not every man will experience the same side effects and with the same degree of intensity.
With out knowing your other “numbers” it is difficult to get specific. Each man needs to make their own choice, but with open and educated eyes.
diagnosed 6 years ago at the age of 57……..gleason 4+3..63 seeds(palladium) implanted plus 25 external doses….can you give recurrence %?
George – Generally approximately 1/3 of all men treated prostate cancer will have a recurrence. This is a pretty consistent number that spans all treatment. The actual recurrence rates don’t matter as these only measure a group trend and do not measure or even predict what might happen to a single individual, you. – Joel
5 years ago my prostate biopsy showed 5 percent of one sample malignant
with a Gleason score of 3-3. I went into watchful waiting at Johns Hopkins under
Dr Ballentine Carter. In five years of multiple manual exams, biopsies, and MRIs
no cancer was detected. I did my last biopsy last month locally in Austin and my urologist
reported one of 12 samples showed 15 percent cancer with a Gleason score
of 4-3. I am now trying to decide what treatment to pursue or to continue watchful
waiting. I am 71. My father died of cancer emanating from his prostate
at age 71. May I have your advice?
Tom, The very first thing you should do is have a second opinion done on your latest biopsy. Most people don’t realize that pathology is subjective and it is possible that another pathologist might not agree with the current finding. You can read more about this at: http://malecare.org/second-opinion-on-biopsy-slides/ – Joel
Doesn’t the cell become less differentiated as the Gleasons number increases, not ” more differentiated ” as stayed in the first sentence of paragraph two?
Don, The higher the Gleason grade the more differentiated the cells. Non-cancerous cells are very orderly, similar in appearance and tightly packed together. As the cancer develops the cells separate, become irregularly shaped and no longer look like each other. – Joel
Joel, thanks for doing this Blog.. I just found out that I am of the 3+4=7 I had 4 out of 12 cores 2 were 3+4=7 and 50% the others were 3+3=6 10% and 5%. The Doc thought that watchful waiting would not be a good option due to my age <65 and the 3+4 being 50% my PSA is a 5. Meeting with Surgeon and Radiation oncologist in two days..