Gleason Scores

The Gleason grading system assigns a grade to each of the two largest areas of prostate cancer in a tissue sample. Grades range from 1 to 5, with 1 being the least aggressive and 5 the most aggressive. Grade 3 tumors, for example, seldom have metastases, but metastases are common with grade 4 or grade 5.

The two grades are then added together to produce a Gleason score. A score of 2 to 4 is considered low grade; 5 through 7, intermediate grade; and 8 through 10, high grade. A tumor with a low Gleason score typically grows slowly enough that it may not pose a significant threat to the patient in his lifetime.

Once the grade is established, your physician will need to have additional information before determining a course of treatment. He will need to “stage” your tumor which is dependent upon the size and how far it has spread.

There are two systems used for “staging” the tumor. One of them is TNM and the other is ABCD Rating. They both evaluate the size of the tumor and the spread in reference to nearby lymph nodes and if the cancer has spread beyond those parameters.

The staging system determines whether the tumor is “Localized,” “Regional” or Metastatic. Within each of these categories are divided into categories that are more precise.


Using the TNM method, you have Stage I (could also be referred to as T1.) These are tumors that cannot be felt. Using the ABCD method the staging is considered “A.”

TNM Stage II or B or T2 are tumors that you can feel but are still confined to the prostate gland.


In Stage III or C or T3 tumors have broken through the prostate capsule. They may have invaded the seminal vesicles.
T4 indicates that tumors are growing into muscles and organs that are nearby.


Stage IV, D or N+ or M+. This staging refers to tumors that have invaded either the pelvic lymph nodes (N+) or into other distant areas of the body (M+).

If you receive a diagnosis of cancer and different treatment options from your doctor, it would be prudent to get a second opinion. This is a normal practice and one which can help you make intelligent decisions about the most important step you may take in your life.

Getting that second opinion may confirm the diagnosis but help you to adjust the staging and your treatment options. A second opinion may also lead you to a special clinical trial of new cancer treatments that your current physician is not aware of.

Try and locate a prostate cancer support group in your area. Speaking to other men who have experienced prostate disease can do wonders in learning how to deal with your diagnosis and treatment options.