An Expert Discusses What You Need To Know About The Gleason Grading System

At the just concluded PCRI annual prostate cancer patient conference the well-known prostate cancer pathologist, Dr. Jonathan Epstein from John’s Hopkins gave a valuable and important presentation.

In his talk, he mentioned that over time there had been significant changes in the Gleason Grading system.  He said that what was called a 3+3=6 as recently as ten years ago would now be reported as a 3+4 = 7 or even a 4+3=7.

Several times during his presentation he said that a current pathology report of Gleason 3+3 =6 denotes cancer that has virtually zero chance of leaving the prostate capsule.

He also reminded the audience that a 'random' needle biopsy (initial diagnostic biopsy) is inherently inaccurate compared to the biopsy on a whole prostate removed by surgery.  He pointed out that a classic 12 to 14-core needle biopsy just samples about 0.2 % or less of the prostate, whereas a post-surgery biopsy examines the entire organ. 

He also shared that there has been a considerable discussion among the international pathology associations about no longer calling Gleason 3+3 'cancer'.  His opinion, however, since a needle biopsy under-samples the prostate gland, is a bad idea because it might discourage men from this low-risk group from not appropriately following up on an initial positive biopsy.

When asked about the best type of initial diagnostic biopsy he said that it is one targeting the needle cores by a multi-parametric MRI.  He hastened to add that even that has a chance of missing cancer found in a post-surgery whole-organ biopsy.

Like Cancer ABCs, he also highly recommended having biopsy slides sent to a prostate-cancer center of excellence for a second opinion (about $200 and usually covered by insurance).  He said that he finds errors in Gleason scores for 20% or more of the prostate biopsies he reviews.

Looking towards the future, he reported that over the next several years the prostate pathology reports would switch to a new 5-grade biopsy reporting system.  Starting in 2018 prostate pathology reports will report both the oldGleason sums and the new Prostate Cancer Grades:


New         Old

------         -------

Grade 1   Gleason 3+3=6

Grade 2   Gleason 3+4=7

Grade 3 Gleason 4=3=7

Grade 4   Gleason 4+4=8

Grade 5   Gleason Sum 9 (4+5, 5+4), Gleason 5+5=10



Joel T. Nowak, MA, MSW wrote this Post.  Joel is the CEO/Executive Director of Cancer ABCs.  He is a Cancer Thriver diagnosed with five primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma, and Appendiceal Cancer a rare cancer.