Prostate Cancer: Grading

To form your treatment plan, your healthcare 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 looks at this tissue under a microscope. A pathologist is a doctor who identifies diseases by studying cells and tissues. He or she then figures out 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 grouped, 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.

Microscopic view of Grade 1 or 2 prostate cancer cells.

Illustration showing abnormal cells tMicroscopic view of Grade 3 prostate cancer cells.hat vary in size and shape with fewer rings in grade 3 of prostate cancer

  Microscopic view of Grade 4 or 5 prostate cancer cells.

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 mean 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 mean 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 best treatment for your prostate cancer. 

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