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Prostate Cancer: Grading

To form your treatment plan, your health care team must learn more about your cancer. What do the cancer cells look like? Has the cancer spread beyond the prostate? Cells removed during biopsy will be viewed under the microscope. Treatment will depend on how the cells look (grade) and where they are located (stage).

Grading the cancer

A cancer is graded using tissue removed during a biopsy. A pathologist (a doctor who identifies diseases by studying cells and tissues) looks at this tissue under a microscope. He or she then determines the cancer’s grade, from 1 to 5. Low-grade cancers are more similar to normal tissue. High-grade cancers differ from normal tissue in the way cells are organized, and in cell size and shape. The higher the grade, the faster the cancer is likely to be growing. The pathologist will give a report to your urologist.

Illustration showing abnormal cells that still appear as rings in grade 1 or 2 of prostate cancer

Illustration showing abnormal cells that vary in size and shape with fewer rings in grade 3 of prostate cancer

  Illustration showing abnormal cells that vary even more in size and shape in grade 4 or 5 of prostate cancer

Grade 1 or 2

Seen under a microscope, grade 1 or 2 cells are abnormal, but still appear to be organized in rings. This may indicate a slow-growing cancer.

Grade 3

Grade 3 cells vary more in size and shape. Fewer rings are visible. These cancer cells may grow more rapidly or still be slow growing.

Grade 4 or 5

Grade 4 and 5 cells form irregular closely packed rings or don’t form rings at all. They vary even more in size and shape than lower-grade cells. These grades indicate a fast-growing cancer.

The Gleason score

Often there is more than 1 cancer grade within a tumor. The 2 most common grades found in the tumor are added together to get the Gleason score (or sum), a number between 2 and 10. This score helps your urologist figure out the appropriate treatment for your prostate cancer. 


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