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Prostate Cancer: Grades and Stages

Prostate cancer is treated according to its grade and stage. Learn how prostate cancers are classified by stage and grade.

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Grades and Stages of Cancer

Measuring the grade and of prostate 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 prostate cancer is likely to grow and spread. This information helps doctors make decisions on how best to treat it. Doctors use two scales, the Gleason score and the grade group to measure and report the grade of prostate cancer.

What is a Gleason score?

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 prostate cancers will be scored as 6 or higher. The higher the score, the more abnormal and aggressive the cells appear. Using this measuring system, doctors label prostate cancers as low, medium or high grade.

What is a grade group?

Doctors now use an updated "grade group" scoring system, which can give them a better idea of how aggressive a cancer is likely to be. The grade group system uses the two Gleason score numbers to divide prostate cancers into five separate categories.

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Prostate cancer Gleason scores and grade groups

Gleason Score	Grade Group	Description
Gleason score 6	Grade group 1	These are considered low grade prostate cancer. They tend to be slow-growing and less likely to spread.
Gleason score 7	Grade group 2	Grade group 2 cancers have a combined Gleason score of 7 (3+4). This means that larger portion of the cancer is Gleason score 3 than Gleason score 4. These are considered intermediate grade cancers. Grade group 2 cancers have a better outlook than grade group 3 cancers. Even though the total Gleason score is the same for both groups, grade group 2 has less aggressive cancer present.
Gleason score 7	Grade group 3	Grade group 3 cancers have a combined Gleason score of 7 (4+3). This means that a larger portion of the cancer is Gleason score 4 than Gleason score 3. These are considered intermediate grade cancers. Grade group 3 cancers are considered more aggressive than grade group 2 cancers, even though the total Gleason score is the same for both groups.
Gleason score 8	Grade group 4	These are high grade prostate cancer. These are more aggressive and faster-growing cancers. For this reason, they are also known as high risk prostate cancers.
Gleason score 9-10	Grade group 5	These are high-grade prostate cancer. These are more aggressive and faster-growing cancers. For this reason, they are also known as very high risk cancers.

What are the stages of prostate cancer?

The stage refers to whether the cancer has spread beyond the prostate, and if it has, the location in the body where it has spread. Doctors use the following information to stage prostate cancer:

size of the tumor
whether the cancer has spread to nearby
the presence or absence of spread beyond the prostate and lymph nodes ()
levels at the time of diagnosis
Gleason score

Stage	Description
Stage 1	This stage is contained to the prostate, has a Gleason score of 6 or below and a PSA level of less than 10.
Stage 2	The cancer is more advanced but has not spread beyond the prostate.
Stage 3	The cancer extends beyond the prostate but has not spread to lymph nodes.
Stage 4 or metastatic	The cancer has spread to another part of the body outside of the prostate. Common areas of spread include the bladder, rectum, lymph nodes or bones.

Additional tests for staging

After grading and staging, additional tests or imaging may be done to check for cancer spread, though these are not required for all newly diagnosed prostate cancer.

Additional tests are run if: