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Prostate Cancer Diagnosis - Grading, Gleason Scoring and Staging

From About.com

Updated: December 26, 2005

About.com Health's Disease and Condition content is reviewed by V.K. Gadi, MD

Analysis of the Results

Based on the results of testing, a cancer specialist will categorize your cancer in three different ways:

  • Tumor Grading,
  • Gleason Scoring,
  • and Staging.
The results of this categorization allows the specialist to determine the proper course of action to take based on your specific situation.

Tumor Grading

If biopsies confirm cancer cells, those cells are studied to determine how aggessive they are. The samples are studied and compared with healthy prostate cells. The more difference that is found, the more aggressive the cancer cells tend to be. Years of study have allowed the pathologist to identify the cancer cells by size and shape. In the midst of all of the samples, he uses the two most aggressive types of cancer cells that he sees when assigning the grade.

Gleason Scoring

Biopsy samples are examined under a microscope by a pathologist to look for groups of cells making up tissue that is markedly different from healthy prostate tissue. The more different this tissue looks, the more likely the chance that is it malignant and will become aggressive and metastasize. The study involves two tissue samples for different areas of the tumor and gives each sample a score from one to five. The higher the number, the more abnormal the sample. The pathologist adds those two numbers together for that tumor to give it a number known as the "Gleason Score".

Gleason Score Results

  • 2-4 (well differentiated) = pretty normal tissue/mildly aggressive;
  • 5-7 (moderate differentiation) = moderately aggressive;
  • 8-10 (poorly differentiation) = very aggressive.

Pathologists use the term "differentiation" to describe how normal a cancer cell is. If a cell is well differentiated, it is quite normal. A poorly differentiated cell suggests that the tumor will be very aggressive and require quick and aggressive treatment.

Staging

In addition to determining the level of aggressiveness of your cancer, the doctor also uses staging to classify how far your cancer has spread. Cancer is assigned four stages based on how far it has spread:

  • Stage I: Early cancer that is confined to a microscopic area and the doctor and too small to feel when palpated by the doctor.
  • Stage II: The doctor can palpate the tumor, but it is confined only to your prostate gland.
  • Stage III: The cancer has spread to nearby tissues.
  • Stage IV: The cancer has spread to the lymph nodes, bones, lungs or other areas distant from the original tumor.
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