## Gleason Scoring System in Prostate Cancer **Key Point:** The Gleason score is the gold standard histological grading system for prostatic adenocarcinoma and is the single most important prognostic factor after clinical stage. ### System Overview - Grades tumors from 1 (well-differentiated) to 5 (poorly-differentiated) - The score is the sum of the primary pattern (most common) + secondary pattern (second most common) - Range: 2–10 (though 1 is rarely assigned in modern practice) - Higher scores correlate with worse prognosis and higher metastatic potential ### Gleason Score Interpretation | Score | Prognosis | 5-Year Survival | | --- | --- | --- | | 2–4 | Low risk | >90% | | 5–6 | Intermediate risk | 85–90% | | 7 | Intermediate-to-high risk | 70–85% | | 8–10 | High risk | <50% | **High-Yield:** A Gleason score of ≥7 indicates aggressive disease and warrants aggressive treatment (radical prostatectomy or radiation therapy ± androgen deprivation therapy). **Clinical Pearl:** The 2015 ISUP (International Society of Urological Pathology) modified the Gleason grading system, introducing grade groups 1–5 to improve prognostic stratification and reduce inter-observer variability. ### Why Gleason Score Matters 1. Guides treatment decisions (watchful waiting vs. active treatment) 2. Predicts biochemical recurrence after surgery 3. Informs risk stratification for radiation therapy planning 4. Essential for counselling patients on prognosis
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