The Gleason score (sum) is formed by adding the primary and secondary Gleason grades/patterns together as outlined in Table 1 for radical prostatectomy specimens and Table 2 for needle core biopsy specimens. If only one grade is found in the tissue sample, then that grade (the primary Gleason grade) is multiplied by two to give the score. Gleason grades range from 2 to 10 for radical prostatectomy specimens and 5-10 for needle core biopsy specimens (Grades 2-4 are not applicable to needle core biopsy specimens). Table 1: Gleason scoring in radical prostatectomy specimens Number of different grades present | Proportion of grades present | Comments | 1 - Primary | One of 2, 3, 4 or 5 only | Double primary grade to get score
(eg 4+4=8) Record for dominant nodule +/- nondominant (smaller) nodule if of higher grade (if present) | 2 – Primary and secondary | Grades mixed | Report both grades, dominant pattern* first (2+3, 3+4, 4+3 ..) Record for dominant nodule +/- nondominant (smaller) nodule if of higher grade (if present) | | Secondary grade is lower and of limited amount (<5%) | Ignore lower grade – 4+3 becomes 4+4 Record for dominant nodule +/- non dominant (smaller) nodule if of higher grade (if present) | | Secondary grade is higher and of limited amount (<5%) | Include higher grade – 3+3 becomes 3+4 Record for dominant nodule +/- non dominant (smaller) nodule if of higher grade (if present) | 3 – Primary, secondary and tertiary | Grades 2, 3, 4 or 5 | Report dominant grade (largest area) first, then secondary grade (second largest area), then tertiary grade (only if 4 or 5) eg 3+4=7 with tertiary grade 5* eg 2+3=5 with tertiary grade 4* Record for dominant nodule +/- non dominant (smaller) nodule if of higher grade (if present) |
Table 2: Gleason scoring in needle core biopsy specimens Number of different grades present | Proportion of grades present | Comments | 1 - Primary | One of 3, 4 or 5 only | Double grade to get score
(eg 4+4=8) | 2 – Primary and secondary | Grades mixed | Report both grades, dominant pattern first ( 3+4, 4+3 ..) | | Secondary grade is lower and of limited amount (<5%) | Ignore lower grade – 4+3 becomes 4+4 | | Secondary grade is higher and of limited amount (<5%) | Include higher grade – 3+3 becomes 3+4 | 3 – Primary, secondary and tertiary | Grades 3, 4 or 5 | Score the primary grade and the highest grade: eg 3+4+5 becomes 3+5=8 eg 4+5+3=5 becomes 4+5=9 |
* The tertiary grade is recorded separately under the item Person with cancer—histopathological grade, tertiary Gleason grade, code N Note: Dominant (primary) grade is that which occupies the greatest area. More extensive guidelines are available in the Prostate cancer (radical prostatectomy) structured reporting protocol (2nd Ed.) at the Royal College of Pathologists of Australasia website. |