Gleason Score / Grade Group for Prostate Cancer
Pathological grading of prostate cancer. Modern reporting uses Grade Groups 1–5 (from Gleason sum 6 to 10). Guides treatment decision from active surveillance to radical therapy.
Score interpretation
ISUP Grade Group 1. The risk group also needs PSA and T stage.
→ Active Surveillance (AS) is preferred for most Gleason 6 cancers. Criteria: PSA < 10, cT1–T2a, Gleason 6, ≤ 2 positive cores, ≤ 50% core involvement. Protocol: PSA every 3–6 months, annual biopsy (or MRI-targeted). Discuss radical therapy if progression. NICE NG131.
ISUP Grade Group 2 — predominantly pattern 3.
→ Multiparametric MRI prostate pre-biopsy. Discuss: Radical prostatectomy (RARP or open) vs. Radiotherapy (EBRT ± brachytherapy) + 6 months ADT (intermediate unfavourable). Active surveillance may be considered for GG2 select cases. NICE NG131.
ISUP Grade Group 3 — predominantly pattern 4.
→ Multiparametric MRI prostate pre-biopsy. Discuss: Radical prostatectomy (RARP or open) vs. Radiotherapy (EBRT ± brachytherapy) + 6 months ADT (intermediate unfavourable). Active surveillance may be considered for GG2 select cases. NICE NG131.
ISUP Grade Group 4 — Gleason 4+4, 3+5 or 5+3.
→ Staging: bone scan + CT chest/abdomen/pelvis (or PSMA-PET if available). Curative intent if M0: EBRT + long-term ADT (2–3 years) ± docetaxel intensification. RARP option for selected T3 if centre expertise. Metastatic: androgen deprivation therapy (LHRH agonist) + abiraterone or docetaxel + darolutamide (ARASENS). MDT mandatory. NICE NG131.
ISUP Grade Group 5 — Gleason 4+5, 5+4 or 5+5.
→ Staging: bone scan + CT chest/abdomen/pelvis (or PSMA-PET if available). Curative intent if M0: EBRT + long-term ADT (2–3 years) ± docetaxel intensification. RARP option for selected T3 if centre expertise. Metastatic: androgen deprivation therapy (LHRH agonist) + abiraterone or docetaxel + darolutamide (ARASENS). MDT mandatory. NICE NG131.
Interpretation bands for the Gleason Score. Apply clinical judgement and local guidance.
References
- Epstein JI et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2016;40(2):244–252.
- NICE NG131. Prostate cancer: diagnosis and management. 2019 (updated 2021).
Related
Curated clinical cross-links plus same-class fallbacks.
- Prostate Cancer Risk Groups (EAU) · Prostate Cancer
- UCSF-CAPRA Score for Prostate Cancer · Prostate Cancer
- PSA Doubling Time (PSADT) Calculator · Prostate Cancer
- D'Amico Risk Classification for Prostate Cancer · Prostate Cancer
- PSA Velocity and PSA Density · Prostate Cancer
- D'Amico Risk Stratification for Localised Prostate Cancer · Prostate Cancer
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Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.