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Glossary on

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)

Additional tests may be performed on blood or tissue to help guide treatment. For some patients, these tests may help guide the choice of  or 

Get Support
Get Support

The following organizations offer peer support services for people with or at high risk for cancer:

Open Clinical Trials
Open Clinical Trials

The following are studies looking at new methods for , monitoring and finding recurrence in people with cancer.  

A number of other clinical trials for monitoring patients with cancer can be found here.

Last updated January 06, 2024