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 8, 9, or 10 Prostate Cancer?
A Gleason score of 8, 9, or 10 means high-risk prostate cancer. This means all of the cells are abnormal, and more likely to grow faster and spread to other parts of the body.
This includes the following Gleason scores found on a prostate biopsy:
- Gleason score 4 + 4 (Grade Group 4)
- Gleason score 4 + 5 (Grade Group 5)
- Gleason score 5 + 4 (Grade Group 5)
- Gleason score 5 + 5 (Grade Group 5)
Based on the Gleason score or Grade Group alone, these cancer grades are considered high risk. This is true even if the PSA level or cancer stage suggests a lower risk.
How Aggressive Is Gleason Score 8, 9, or 10 Prostate Cancer?
The Gleason score describes how abnormal the cancer cells look under a microscope. It helps doctors understand how aggressive the cancer may be. “Aggressive” means how fast the cancer cells grow and spread.
- Gleason Score 4 + 4: All of the cancer cells are abnormal. These cells are considered likely to be aggressive.
- Gleason Score 4 + 5, 5 + 4, or 5 + 5: All of the cancer cells look very abnormal. These cancers are considered very aggressive. They are more likely to grow and spread.
Additional Tests to Check for Cancer Spread
With Gleason score 8, 9, or 10, more tests are needed to see if the cancer has spread. This will help guide treatment decisions. These tests are called staging studies. They may include:
- Bone scan and computed tomography (CT) or magnetic resonance imaging (MRI)
- Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT)
Based on current National Comprehensive Cancer Network (NCCN) guidelines, a PSMA PET/CT scan is recommended, and does not require a negative bone scan and CT/MRI first.
Active Surveillance and Focal Therapy: Not Good Treatment Options
For most men, prostate cancer with Gleason score 8, 9, or 10 requires treatment. Unless a man has other serious health problems and a very limited life expectancy, active surveillance is not advised. Men with these Gleason scores are also not candidates for focal therapy. This is because of the risk that this approach may not treat all areas of cancer.
Main Treatment Options for Gleason Score 8, 9, or 10 Prostate Cancer
For men whose staging tests do not show cancer spread outside the prostate (metastasis), the 2 main treatment options are:
- Radiation therapy
- Radical prostatectomy (surgery)
Radiation Therapy
Radiation therapy 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) is done along with radiation therapy. This is hormone therapy. This treatment is done for 18 to 24 months. Research has shown that combining radiation therapy with ADT improves survival for many men with high-risk prostate cancer.
Radical Prostatectomy (Surgery)
Radical prostatectomy is surgery to remove the prostate. This procedure is often done using the da Vinci robotic platform.
This option is most often considered for younger men, particularly those with Gleason score 4 + 4 disease.
During radical prostatectomy, some pelvic lymph nodes are removed for testing. They are checked for cancer cells. This helps show if the cancer has spread.
Additional Treatment After Surgery
Some men with Gleason score 8, 9, or 10 who have surgery may need radiation treatment after surgery. This is called salvage radiation therapy.
This is most often needed when:
- The PSA level does not become undetectable after surgery (persistent PSA)
- The PSA level begins to rise again in the months after surgery
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.