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What Does Grade 4 Prostate Cancer Mean

What Do My Test Results Mean

What Does Gleason 7 Mean? | Ask A Prostate Expert, Mark Scholz, MD

Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.

How far has my cancer spread?

The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.

Depending on the results, your cancer may be treated as:

Is my cancer likely to spread?

Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.

Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.

To work out your risk, your doctor will look at your PSA level, your Gleason score and the T stage of your cancer.

Low risk

Your cancer may be low risk if:

  • your PSA level is less than 10 ng/ml, and
  • your Gleason score is 6 or less , and
  • the stage of your cancer is T1 to T2a.

Medium risk

Your cancer may be medium risk if:

  • your PSA level is between 10 and 20 ng/ml, or
  • your Gleason score is 7 , or
  • the stage of your cancer is T2b.

High risk

What happens next?

The Tnm System For Prostate Cancer Stages

As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:

  • Tumor. Whatâs the size of the main area of prostate cancer?
  • Nodes. Has it spread to any lymph nodes? If so, how far and how many?
  • Metastasis. How far has the prostate cancer spread?

Prostate Cancer Stagemeans For Treatment

The stage of your prostate cancer isnt a result of one factor. Multiple tests are required to evaluate the aggressiveness of the cancer in your cells and the how far it has spread. Some of these tests include a Digital Rectal Exam , blood tests, imaging studies and biopsy results. Before you choose a treatment plan, its beneficial to familiarize yourself with how your stage is assigned, why it can influence your treatment decisions and what it means for the future.

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What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia

All of these are terms for things the pathologist might see under the microscope that are benign , but that sometimes can look like cancer.

Atrophy is a term used to describe shrinkage of prostate tissue . When it affects the entire prostate gland it is called diffuse atrophy. This is most often caused by hormones or radiation therapy to the prostate. When atrophy only affects certain areas of the prostate, it is called focal atrophy. Focal atrophy can sometimes look like prostate cancer under the microscope.

Atypical adenomatous hyperplasia is another benign condition that can sometimes be seen on a prostate biopsy.

Finding any of these is not important if prostate cancer is also present.

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Determining The Stage Of Your Prostate Cancer

Using the results of your tests, your doctor will calculate a score based on four main components. Namely your: 1) PSA level, 2) Gleason score , 3) T-stage and 4) whether the cancer has metastasized. The information below breaks down each component so you have a better understanding of what your results mean and where they land in the spectrum of cancer prognoses.

What Are The Damico Risk Categories

The DAmico system provides an estimate of the risk of recurrence at five years after treatment. This system is one of the most widely used for risk assessment. It combines the PSA, Gleason score, and the clinical stage to create low, intermediate, and high risk categories. The higher the risk category, the higher the chance of recurrence is five years after treatment.

The DAmico risk categories are below. If one factor is putting you in a lower category but another is putting you in a higher category, then the higher category takes precedent.

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What Is A Grade Group

In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system, called the Grade Groups.

The Grade Group system is simpler, with just five grades, 1 through 5.

*Risk Groups are defined by the Grade Group of the cancer and other measures, including PSA, clinical tumor stage , PSA density, and number of positive biopsy cores.

Many hospitals report both the Gleason score and the Grade Group, but there may be hospitals that still report only the old Gleason system.

How Is Prostate Cancer Diagnosed

Prostate Cancer Grade and What it Means

Doctors describe the growth and spread of prostate cancer in stages. Doctors use these stages as guides when choosing treatment options or offering prognoses to their patients.

Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests such as a digital rectal exam or prostate-specific antigen test and imaging studies like bones scans, MRIs, CT scans, and trans-rectal ultrasounds.

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Questions To Ask Your Doctor

To help understand the progression of prostate cancer, discuss these questions with your doctors:

  • What is my Gleason score?
  • Has the cancer spread outside my prostate?
  • Whats my prostate cancer stage?
  • Are other tests needed to determine my cancer stage?
  • What are the treatment options for my stage of cancer?
  • Can I avoid treatment right now and go on active surveillance?

What Does It Mean If My Biopsy Report Mentions The Word Core

The most common type of prostate biopsy is a core needle biopsy. For this procedure, the doctor inserts a thin, hollow needle into the prostate gland. When the needle is pulled out it removes a small cylinder of prostate tissue called a core. This is often repeated several times to sample different areas of the prostate.

Your pathology report will list each core separately by a number assigned to it by the pathologist, with each core having its own diagnosis. If cancer or some other problem is found, it is often not in every core, so you need to look at the diagnoses for all of the cores to know what is going on with you.

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How Prostate Cancer Spreads And Progresses

Prostate cancer grows within the prostate gland, often for many years. Over time, the cancer spreads outside the prostate. This happens in one of three ways:

  • It grows into nearby tissues
  • It spreads through your system of lymph nodes and lymph vessels
  • It travels to distant tissues through your blood

Prostate cancer stages describe how far the cancer has spread.

Understanding Your Pathology Report: Prostate Cancer

Prostate Cancer Gleason Score

When your prostate was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy.

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How Does Gleason Scoring Work

If your doctor suspects you have prostate cancer a biopsy may be used to confirm the diagnosis and gain insight its characteristics. The two most dominant grades of cancer cells found in the biopsy are each given a score of 1 through 5.

For instance, a patient may be assigned a 4 and a 3. These two numbers are then added together to determine the Gleason Score which is a range of 2-10. In most cases, oncologists never assign a Gleason Score below 6. If we go back to our example, 4 and 3 would be added together for a sum of 7. This means 7 would the patient’s Gleason Score.

What Does It Mean When There Are Different Core Samples With Different Gleason Scores

Cores may be samples from different areas of the same tumor or different tumors in the prostate. Because the grade may vary within the same tumor or between different tumors, different samples taken from your prostate may have different Gleason scores. Typically, the highest Gleason score will be the one used by your doctor for predicting your prognosis and deciding on treatment options.

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Prostate Cancer Stages Range From 1 To 4

The most easy-to-understand staging system groups cancer into stages 1 to 4, the American Cancer Society says, with stage 1 the earliest prostate cancer and stage 4 when the cancer has spread throughout the body. This is used for many cancers. Your doctor is likely to tell you your stage of cancer using this system.

What Do Cancer Stages And Grades Mean

Prostate Cancer and Gleason Score or Group Video

The stage of a cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells.

If you’re diagnosed with cancer, you may have more tests to help determine how far it has progressed. Staging and grading the cancer will allow the doctors to determine its size, whether it has spread and the best treatment options.

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What Is Stage 4 Cancer

Stage 4 cancer is sometimes referred to as metastatic cancer, because it often means the cancer has spread from its origin to distant parts of the body. This stage may be diagnosed years after the initial cancer diagnosis and/or after the primary cancer has been treated or removed.

When a cancer metastasizes to a different part of the body, it is still defined by its original location. For instance, if breast cancer metastasizes to the brain, it is still considered breast cancer, not brain cancer. Many stage 4 cancers have subcategories, such as stage 4A or stage 4B, which are often determined by the degree to which the cancer has spread throughout the body.

Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:

  • The ratio of healthy blood cells to cancerous cells
  • The degree to which lymph nodes, the liver or spleen may be swollen
  • Whether the cancer has resulted in blood disorders such as anemia

Stage 4 cancer is determined in the five most common cancers this way:

Biopsy: What The Diagnosis Means

The pathologist has just looked under the microscope at 12 tissue samples from your prostate. Whats in there? First, there are normal cells. Pathologists can tell that theyre normal, because they are round and uniform, with well-defined edges and clear centers. As cancer progresses, the cells become more oblong then more irregular. The edges get blurred, and eventually, the outside shapes start to get weird so do the insides. What once looked like pebbles drawn with a fine-tip pen, as the cancer gets more aggressive, ends up looking like ragged clumps of algae drawn with a fat crayon.

But wait theres more! A sample of prostate cells might also include atypical cells, which are a big question mark. Theyre not normal, but the pathologist cant definitely report that theyre cancerous, either. Theyre just suspicious.

Note: This is one reason why you may want to get a second opinion on your biopsy slides from a pathologist who is an expert in prostate cancer. Having your slides sent to another pathologist is a lot cheaper than having a repeat biopsy just to get more conclusive information.

Gleasons original system had more than 25 different possible combinations. That has just been simplified into a new system, called grade groups, by Jonathan Epstein at Johns Hopkins. The World Health Organization has accepted Epsteins new system, and your hospital may already be using it. Heres what you need to know:

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Stage : Prostate Cancer Is Limited To A Small Part Of The Prostate

  • Often, the cancer is found as a result of needle examination of tissue for another reason, such as benign prostatic hypertrophy , also known as an enlarged prostate, or because of an elevated result on a prostate specific antigen test, which uses PSA levels as an indicator of potential cancerous growth.
  • Cancer cells are only found in a small part of the prostate. The cells look like normal cells and the prostate feels normal with a digital rectal exam .
  • PSA is less than 10.
  • Gleason score, which assigns a grade to what the cancer cells looks like under a microscope, is less than 6, the Prostate Cancer Foundation notes.

Stages Of Prostate Cancer

Staging and Grading

Any T, any N, M1

Any Grade Group


The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.

Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.

While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.

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Gleason Score For Grading Prostate Cancer

Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.

The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.

Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.

Treatment Of Stage Iv Bcp

Therapy is usually systemic, i.e. directed at the whole body. Depending on the situation, the doctor may prescribe:

  • surgery. Removal of the prostate gland at the 4th stage of cancer in Russia is only possible in clinical trials. Surgical intervention can remove the main tumor and metastases to the nearest lymph nodes, but it will not help with distant metastasis
  • hormone therapy. It aims to slow down or stop the progression of the tumour. It is usually an anti-androgenic treatment, i.e. it suppresses the production of male sex hormones
  • chemotherapy primarily drugs such as docetaxel and cabazitaxel
  • radiation therapy. At stage 4, radiation to the prostate is used only if the number of metastatic lesions is small . Palliative radiotherapy can also be used: it helps to shrink the tumor and reduce the severity of symptoms.

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How Do Prostate Cancer Stages And Grades Affect Survival Rates

Overall, the prostate cancer survival rate is 98%, and most men with this disease will die of other conditions rather than the prostate cancer itself. However, if you look at survival rates by stage, it has been shown that the more advanced forms of prostate cancer have a lower survival rate. The National Cancer Institutes Surveillance, Epidemiology, and End Results Program , which is the database that compiles the incidence and survival rates, sorts prostate cancer into localized, regional, and distant rather than using the TNM system .

  • Localized- cancer has not spread outside of the prostate
  • Regional- cancer has spread outside of the prostate to adjacent structures and lymph nodes
  • Distant- cancer has spread to remote parts of the body, such as bones, liver, or lungs

Here are the 5-year relative survival rates for men with prostate cancer based on the SEER database information.

SEER stage

You can learn more about prostate cancer survival rate by clicking here.


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