The Gleason score is a numerical score used to evaluate prostate cancer severity and develop a treatment plan. It is calculated by adding the primary and secondary areas of cancer on a scale of one to five. The lower the score, the better the prognosis, but other factors must also be considered when making treatment decisions.
A Gleason score is a numerical score assigned to prostate cancer after it has been evaluated by a pathologist under a microscope in the laboratory. The Gleason score is used to calculate basic information about the cancer in order to determine its severity and develop a treatment plan. A number of other details about the cancer are included in the pathology report so that the medical team has a complete picture of the situation.
To determine the Gleason score, a pathologist examines a sample of prostate tissue under a microscope. The pathologist identifies areas of abnormal cell growth and finds the primary and secondary areas of cancer. First, the primary area is inspected and its appearance compared to the Gleason scale system to determine where it falls on a scale of one to five. Then the secondary area is examined and also staged one to five. The Gleason score is calculated by adding the two numbers and ranges from two to 10.
The Gleason scale, named after Dr. Donald Gleason, was developed in the 1960s and uses only the cellular aspect to classify cancer. The scale ranges from one well-differentiated cell suggesting slow-growing cancer or even a normal prostate, to five poorly differentiated cells indicating the cancer is aggressive. Stages one and two on the scale are rare, because prostate cancer usually isn’t identified until at least some have progressed to a stage of three or four on the scale.
The lower the Gleason score, the better the prognosis. In some cases, a doctor may determine that the cancer is growing so slowly that treatment may not be needed immediately by focusing on monitoring the patient for signs of changes. A Gleason score as high as nine indicates that the cancer is aggressive and rapidly growing and that treatment must be decisive and equally aggressive.
The Gleason score alone cannot be used to develop a treatment plan or make decisions about how to treat cancer. There are a number of factors that the medical team and patient need to consider when discussing treatment options. Someone with a high Gleason score who is already dying from another condition, for example, might choose to decline treatment, assuming it wouldn’t add much additional quality of life and that the rigors of treatment could be very unpleasant.
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