What is a Gleason Score?
With prostate cancer, the Gleason Score is a measurement of how fast-growing and widespread the cancer is. After you have a prostate biopsy, a doctor called a pathologist looks at the sample of prostate tissue with a microscope.
When a pathologist looks at prostate biopsy tissue under a microscope, they look for details about the cancer cells. These details include how abnormal the cancer cells look, and how they may grow and spread. Very abnormal cells tend to grow more quickly, spread, and invade other tissues. This is referred to as aggressive. More details about this are in our risk stratification content.
Learn more about Gleason scores here.
What Does It Mean to Have Gleason Score 7 Prostate Cancer?
Gleason score 7 prostate cancer is the name for 2 different types of prostate cancer:
- Gleason score 3 + 4 (Grade Group 2)
- Gleason score 4 + 3 (Grade Group 3)
Although both types have a Gleason score of 7, they do not behave the same way. The order of the numbers shows which cancer cells are most common.
Both types are considered intermediate-risk prostate cancer. However, a man with Gleason score 7 prostate cancer may have higher-risk disease if he also has:
- A high PSA level (greater than 20 ng/mL)
- A more advanced tumor stage (if and where cells have spread)
Gleason Score 3 + 4 (Grade Group 2) Prostate Cancer
In Gleason score 3 + 4 (Grade Group 2) prostate cancer, most of the tumor cells are the less aggressive Gleason 3. A smaller portion of the tumor are the more aggressive Gleason 4 cells.
Because most of the cancer is made up of the less aggressive cells, Gleason score 3 + 4 prostate cancer is generally expected to grow more slowly than Gleason score 4 + 3 (Grade Group 3) prostate cancer.
Unless the PSA level is greater than 10 ng/mL, most doctors will not order additional imaging tests to look for spread of the cancer in men with Gleason score 3 + 4.
Gleason Score 4 + 3 (Grade Group 3) Prostate Cancer
In Gleason score 4 + 3 prostate cancer, most of the tumor cells are the more aggressive Gleason 4, with a smaller amount as Gleason 3.
Because of the larger amount of more aggressive cancer cells, Gleason score 4 + 3 prostate cancer is more likely to grow and spread than Gleason score 3 + 4.
For this reason, most doctors will recommend additional imaging tests to help see if the cancer has spread. These tests may include:
- Computed tomography (CT) scans
- Magnetic resonance imaging (MRI)
- Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT)
What Are Treatment Options for Gleason Score 7 Prostate Cancer?
If the PSA level is less than 20 ng/mL and there is no evidence of cancer spread outside the prostate (or the risk of spread is low), treatment options may include:
- Active surveillance in some cases
- Focal therapy in some cases
- Radiation therapy
- Surgery
Treatment Options for Gleason Score 3 + 4 Prostate Cancer
Active Surveillance
Active surveillance means closely monitoring the cancer with regular testing rather than treating it right away.
Some men with Gleason score 3 + 4 prostate cancer may be candidates for active surveillance. This may include:
- Men older than age 70
- Men with other health problems
- Men with a small amount of cancer found on biopsy (about 1 to 2 positive biopsy cores)
What Happens If You Choose Active Surveillance?
Men who choose active surveillance are monitored regularly. Follow-up usually includes:
- PSA blood tests (often every 6 months)
- MRI scans, if one has not already been done
- A confirmatory biopsy (see below)
The confirmatory biopsy is more tissue taken after the original diagnostic biopsy. This second biopsy helps make sure that a more aggressive cancer was not missed during the first biopsy.
Focal Therapy
Some men with Gleason score 3 + 4 disease may be candidates for focal therapy. This may be an option for men who have a visible target (known as an index lesion) on MRI.
One type of focal therapy is high-intensity focused ultrasound (HIFU). This uses focused sound waves to treat areas of cancer within the prostate.
Radiation Therapy or Surgery
For most men with Gleason score 3 + 4 prostate cancer, especially younger and healthier men, traditional treatment options are usually recommended.
These options include:
- Radiation therapy: This may be done with a machine that directs radiation into the prostate. This is called external beam radiation therapy (EBRT). Or it may be done with small radioactive pellets placed inside the prostate. This is called brachytherapy.
- Surgery: Surgery is done to remove the prostate. This is called a radical prostatectomy. This procedure is often done using the da Vinci robotic platform.
For men who choose radiation therapy, hormone therapy (androgen deprivation therapy, or ADT) is usually not needed during or after treatment for Gleason score 3 + 4 prostate cancer.
Treatment Options for Gleason Score 4 + 3 Prostate Cancer
Most men with Gleason score 4 + 3 prostate cancer will need treatment. They are generally not candidates for active surveillance.
Most men with Gleason score 4 + 3 prostate cancer have these treatment options:
- Radiation therapy: This may be done with a machine that directs radiation into the prostate. This is called external beam radiation therapy (EBRT). Or it may be done with small radioactive pellets placed inside the prostate. This is called brachytherapy.
- Androgen deprivation therapy (ADT): This is hormone therapy that’s done along with radiation therapy. This treatment is done for about 6 months.
- Surgery: Surgery is done to remove the prostate. This is called a radical prostatectomy. This procedure is often done using the da Vinci robotic platform.
Very few men with Gleason score 4 + 3 disease are candidates for focal therapy. This is because of the higher risk that focal therapy may not treat all of the cancer.
Talking With Your Healthcare Team
The best treatment for you depends on these factors:
- Your Gleason score
- The amount of cancer found
- Your age and overall health
- Your personal preferences
Talk with your doctor about your Gleason score, test results, treatment options, and preferences. Together you can decide the best type of treatment for you.