Grading Your Prostate Cancer

Grading is a way of describing what your cancer cells look like. It provides an indication of how quickly the tumour is growing and how likely it is to spread.

Your biopsy samples will be viewed under a microscope by a pathologist to see what any cancer cells look like. The cells will be given a grade from 3 to 5. Grade 3 tumours look relatively similar to normal prostate cells, whereas grade 5 cells look very different.

The two most frequently occurring grades seen in the biopsy samples are added together to give a Gleason score, which ranges from 6 to 10. The higher the Gleason score, the more active the cancer and the more likely it is to spread.

The new ISUP grading system

There is a new grading system for prostate cancer known as the ISUP grading system (named after the International Society of Urological Pathology). This new system grades the cancer between 1 and 5 depending on your Gleason score. The lower the grade, the less likely the cancer is to spread. This helps your treatment team to plan your treatment.

Grading of prostate cancer


ISUP

grade

Gleason score

Description of the two patterns

1

3+3=6

The cancer cells found in the biopsy are likely to grow slowly.

Note the difference between 3+4 and 4+3, which are both Gleason score 7

2

3+4=7

Most of the cancer found in the biopsy looks likely to grow slowly.

There are some cancer cells that look more likely  to grow at a more moderate rate.

3

4+3=7

Most of the cancer cells found in the biopsy look likely to grow at a moderate rate.

There are some cancer cells that look likely to grow slowly.

4

4+4=8

All of the cancer cells found in the biopsy look likely to grow at a moderately quick rate.

Note the difference between 4+5 and 5+4, which are both Gleason score 9

5

4+5=9

Most of the cancer cells found in the biopsy look likely to grow at a moderately quick rate.

There are some cancer cells that are likely to grow more quickly.

5

5+4=9

Most of the cancer cells found in the biopsy look likely to grow quickly.

5

5+5=10

All of the cancer cells found in the biopsy look likely to grow quickly.

 

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