Gleason grading system for prostate cancer

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In addition to staging, prostate cancer is graded to determine how aggressive or fast growing the tumour is. Cells taken during your biopsy are graded according to their appearance under a microscope. Normal cells have certain distinguishing characteristics. Aggressive cancer cells do not have distinguishing  marks of normal cells.

There are several grading systems, but the Gleason system is the most common. It ranges from a score of 4 (the lowest) to 10 (the highest). Lower scores (4-6) mean that they are usually less aggressive and a score of  8-10 means the cancer are more likely to be aggressive.

Histological Grading of Prostate Cancer - Gleason system 

Grade 2 Well differentiated carcinoma with some variation in size and shape of glands
Grade 3 Moderately differentiated adenocarcinoma either

a) polymorphic differentiated glands separated by abundant stroma arranged in poorly defined clumps or

b) well defined cribriform or papillary masses which generally correspond to intra-duct spread.

Grade 4 Poorly differentiated adenocarcinoma. Tumour clumps are poorly defined and differentiated with fixed glands widely infiltrating prostatic stroma
Grade 5 Undifferentiated carcinoma

Carcinoma with no or minimal very poorly differentiated gland formation, and marked stromal infiltration. Central necrosis may be present in tumour cell mass

(Gleason score (4-10) is sum of scores of primary & secondary morphological patterns).


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