Prostate Health

Gleason Scores

After a tissue sample is taken from the prostate, a grade is assigned to each of the two largest areas of cancer -- known as the Gleason grading system. Grades range from 1 to 5, where 5 is the most aggressive and 1 is the least aggressive. Grade 3 tumors, for instance, rarely have metastases, but metastases can be quite common with a grade of 4 or 5.

Next, the two grades are added together to produce what is known as a Gleason score. A score of 2 to 4 is considered low grade; 5 to 7 is an intermediate grade; and 8 to 10 is a high grade. A tumor with a low Gleason score usually grows slowly enough so as not to pose a significant threat to the patient during his lifetime. Once the grade has been established, your physician will then want some additional information from you before determining the best course of treatment. He will need to "stage" your tumor, which depends on how far the tumor has spread and its size.

Two systems are used for "staging" the tumor. One is called TNM and the other is called ABCD Rating. They both evaluate the spread of the tumor with respect to nearby lymph nodes (and whether or not the cancer has spread beyond the lymph nodes) and the size of the tumor. This staging system determines if the tumor is Localized, Regional or Metastatic. Each of these categories are also divided into subcategories that are more precise.


If you use the TNM system during Stage I prostate cancer (also referred to as T1), the tumors cannot be felt. When the ABCD method is used, the staging is considered "A." During a TNM Stage II or B or T2, the tumors can be felt but they are are still confined to the prostate gland and have not spread.


During Stage III prostate cancer, or C or T3, the tumor has broken through the prostate capsule. The cancer could have invaded the seminal vesicles. T4 indicates that the tumor has grown into nearby organs and muscles.


This is known as Stage IV, D or N+ or M+. This stage refers to cancer that has invaded the pelvic lymph nodes (N+) and/or into other areas of the body (M+).

If you receive a diagnosis of prostate cancer and several different treatment options from your physician, it wise to seek out a second opinion. This is standard practice and will help you make a smart decision about the most important step you may take during your life. Receiving a second opinion may confirm the diagnosis, but also help you adjust the staging diagnosis and the treatment options available to you. Getting a second opinion could also possibly lead you to a special clinical trial of new cancer treatments that your current doctor may not be aware of.

Try to locate a prostate cancer support group in your area. Talking to other men who have experienced prostate disease will do wonders for helping you learn how to deal with your treatment options and diagnosis.


Some specific physical tests may reveal the presence of prostate cancer. The PSA, or prostate specific antigen test, is used to detect the disease most often. If a prostate cancer diagnosis is suspected, a confirmation test will very often be administered. Usually, a small piece of the prostate will be removed with a probe and then examined under a microscope. Other tests such as bone scans and x-rays are also useful for detecting prostate cancer and determining if it has spread.