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The most common system to evaluate and describe prostate cancer currently in use is the Gleason grading system. After a biopsy, the pathologist assigns a primary grade from 1 to 5, with 5 being the most aggressive, to the pattern of cancer cells occupying the greatest area of the biopsy cores. A secondary grade is assigned to the pattern occupying the second largest area. These two grades added together determine the Gleason score. 

This score ranges from 2 to 10. It is generally agreed that tumors with a Gleason score of 2 to 4 are very uncommon but have a very low biological aggressiveness. Scores of 5 to 6 have low aggressiveness. Those men with a Gleason score equal or greater than 7 have more biologically aggressive tumors. Those with primary scores of 3 and secondary scores of 4 are thought to have intermediate aggressiveness. Primary Gleason grades of 4 or 5 are an indication of aggressive prostate cancer.

If you feel you need a basic tutorial on prostate cancer, we suggest, Knowing Your Options: A Decision Aid for Men With Clinically Localized Prostate Cancer. It provides information about prostate anatomy, clinically localized prostate cancer and an introduction to treatment options, including the choice to not begin treatment immediately.

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