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what is a Gleason score

Posted 08 May 2021 at 11:28

My husband has had the results from his biopsy. Some of the samples were showing cancer and the Gleason score was 6 or 7 . Can someone explain what this actually  means ? They are recommending monitoring and regular blood tests. 

Posted 08 May 2021 at 13:02
Cancer cells are divided into three grades: 3 (the least aggressive), 4 ( moderately aggressive) and 5 (the most aggressive). Your Gleason score will be expressed as a sum of two numbers, eg "3+4=7". The first number is the grade of the most numerous cancerous cells seen in the biopsy samples; the second number is the grade of the second most numerous cancerous cells. Thus, "3+4" means "mainly less aggressive with some moderately aggressive", while "4+3" means "mainly moderately aggressive with some less aggressive". It is, therefore, important to know the two numbers, not just their sum.

Hope that helps,


Posted 08 May 2021 at 14:32

Thanks. I don't know if he was given the two numbers. I shall have to check. But we remain hopeful that it is the less aggressive. Thanks for the help.

Posted 08 May 2021 at 14:41

The first thing to know is that 6 or 7 in a man in his 60s is not a bad score (it is also not a good score, but I am an optimist). The gleason score runs from 1 to 10. A score of 5 or below is considered cancer free and you will never see these scores on this forum as no urologist bothers quoting the number they just say "well done, cancer free". A score of 6 or 7 means troublesome but may not go on to kill you. 8 or above means there are enough severely abnormal cells that the cancer may progress. 

All cancer treatments have side effects. For low risk cancers you have to balance the massive inconvenience of permanent incontinence from treating a cancer which was never going to be a problem, and you are more likely to die of heart disease or a car accident in twenty years time than from the cancer. For high risk cancers, you have to balance the minor inconvenience of permanent incontinence against the high chance of an unpleasant death from cancer. 

To really understand the above paragraph you have to know all the potential side effects of the treatments and what the real chance of any happening actually are. Over the last 20 years treatment has improved and the chances and severity of side effects have reduced. 

Your husband with a score of 6 or 7 falls in the first group, the treatment is likely to be worse than the disease. It needs watching because it may get worse, but it probably won't need treating, and the later you can leave it the longer he can live a pleasant life without side effects.

For some men the worry that the cancer may get worse is sufficient that they are prepared to risk the side effects of treatment even when the cancer is not thought to be troublesome, that is a personal choice. Other men are so averse to treatment they risk death from cancer rather than unpleasant side effects that is a personal choice. 

Remember we will all die of something some time. I had a score of 9; my ambition was to die of a heart attack whilst attending an orgy organised by the members of Girls Aloud. My oncologist said with a score of 9 the cancer was more likely to kill me first. So I opted for treatment (he didn't actually say my chances of an orgy with Girls Aloud had increased, but I took it that way, remember I am an optimist). 

Chris has explained how the gleason score is calculated the only thing I would disagree with in Chris's explanation is that he has ignored the type 1 and 2 cells, quite reasonably as they are not considered cancerous. But only if you know they exist and that the score is obtained by adding two numbers together can you understand why 6 is considered the lowest at risk score rather than 1.

Edited by member 08 May 2021 at 14:45  | Reason: Not specified


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