Grades and stages of cancer
Measuring the grade and of cancer helps doctors decide how to treat it.
Grades, Gleason score and grade groups
The grade of a cancer helps doctors predict how quickly the cancer is likely to grow and spread. Doctors use a scale called the Gleason score to measure and report the grade of cancer. The Gleason score is based on how abnormal the cells appear in the two largest areas of the tumor. The pathologist assigns a score of 1-5 for each area and adds them together for the Gleason score. Although Gleason scores can range from 2-10, most cancers will be scored as 6 or higher. The higher the score, the more abnormal and aggressive the cells appear.
- A score of 6 is low grade.
- A score of 7 is intermediate grade.
- A score of 8 to 10 is high grade.
An updated "grade group" system is now in use. A grade group score is related to a Gleason score:
- Grade Group 1: Gleason score <=6
- Grade Group 2: Gleason score = 7 (3+4)
- Grade Group 3: Gleason score = 7 (4+3)
- Grade Group 4: Gleason score = 8
- Grade Group 5: Gleason score = 9-10
The refers to whether the cancer has spread beyond the , and if it has, the location in the body where it has spread. Doctors use the following information to prostate cancer:
- size of the tumor
- whether the cancer has spread to nearby
- the presence or absence of spread beyond the and ()
- levels at the time of diagnosis
- Gleason score
Using this information, cancer is grouped into four stages, with 1 being the least advanced and 4 being the most advanced.
- 1 cancer is contained to the , has a Gleason score of 6 or below and a level of less than 10.
- 2 cancer is more advanced but has not spread beyond the .
- 3 cancer extends beyond the but has not spread to .
- 4 ( prostate cancer) has spread to another part of the body outside of the . Common areas of spread include the bladder, rectum, or bones.
Additional tests for
After grading and , additional tests or imaging may be done to check for cancer spread, though these are not required for all men with newly diagnosed cancer.
Additional tests are run if:
- levels are high
- The Gleason score is high
- The cancer is large
- The cancer has spread to or beyond
The tests may include:
- Computed tomography (CT) scans of the abdomen and pelvis
- Bone scans
- Magnetic resonance imaging () of your pelvis
- Positron emission tomography (PET) scans.
- Pelvic lymph node dissection (PLND)
The following organizations offer peer support services for people with or at high risk for cancer:
- FORCE peer support
- Visit our message boards.
- Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Sign up for our Peer Navigation Program.
- Users are matched with a volunteer who shares their mutation and situation.
- Join our private Facebook group.
- Find a virtual or in-person support meeting.
- Join a Zoom community group meeting.
- Visit our message boards.
- ZERO-The End of Cancer is a nonprofit organization that provides information and support resources for men with cancer.
The following are studies looking at new methods for , monitoring and finding recurrence in people with cancer.
- NCT02282137: 68Ga-PSMA PET-CT Scan for Diagnosis and Management of Cancer (PSMA). This study looks at 68Ga-PSMA-11 PET-CT scan works to detect tumor location and size in patients with suspected or confirmed cancer, as well as cancer that may have come back.
- NCT04030338: (PSMA) PET Scans to Find Cancer. The purpose of this study is to find out if PET scans using PSMA are accurate and better at finding cancer than the usual methods.
- NCT04716725: 68Ga-PSMA-11 PET for the Diagnosis of Castration Resistant Cancer. This trial aims to see whether using 68Ga-PSMA-11 PET scans may help doctors learn more about where disease is located in the body.
- NCT04777071: An Investigational Scan (68Ga-PSMA-11 PET/CT) for the Imaging of Cancer. This trial studies how well 68Ga-PSMA-11 PET/CT scan works in imaging patients with cancer.
- NCT04867603: Digital PET/CT Using [Ga-68]PSMA for Characterization of Lesions. This study will evaluate a radioactive diagnostic drug called Gallium-68 Specific Membrane Antigen ([Ga-68]PSMA) to tell if abnormalities are cancer.
- NCT05160597: Image-Guided (68Ga-PSMA-11 PET/CT) Biopsy for the Diagnosis of Cancer in Men With Prior Negative/Inconclusive Biopsy. This study looks at how well an image-guided biopsy using the imaging agent 68Ga-prostate-specific membrane antigen (PSMA)-11 with a PET/CT scan works in diagnosing cancer in men with a prior negative or inconclusive biopsy.
A number of other clinical trials for monitoring patients with cancer can be found here.