Gleason Grading System
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Treatment Options and Gleason Grade With Drs. James Eastham, Michael Morris, and Michael Zelefsky, moderated by WCBS-TV's Max Gomez |
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Physicians characterize the aggressiveness of prostate cancer using the Gleason grading system, which provides an estimate of the cancer's potential to grow and spread to other parts of the body. The pathologist determines the Gleason grade based on how closely the cells of the gland resemble those of a normal prostate. A tumor whose cellular structure is close to normal is unlikely to be aggressively malignant and to spread -- and will be assigned a low combined Gleason score -- whereas a tumor that has little resemblance to a normal prostate is more likely to be aggressive and spread outside the prostate and will receive a high combined Gleason score (greater than or equal to 7). Memorial Sloan-Kettering's pathologists have an exceptional depth of expertise in analyzing prostate samples, and their skill is critical in helping the other members of the prostate care team determine the most effective course of treatment for each patient.
Treatment is usually recommended for high-grade cancers, while observation may be recommended for low-grade cancers, especially when the patient is elderly or has other medical conditions.
Diagnostic Imaging
Physicians may also perform various imaging tests to determine the extent of the tumor in the prostate and whether cancer cells have spread to surrounding tissues or other parts of the body. Depending on the findings of the DRE, PSA level, biopsy, and Gleason score, these tests may include:
- MRI using an endorectal or surface coil to help assess the extent of the tumor in the prostate and surrounding tissues
- CT scans or radionuclide bone scans to see if the disease has spread to lymph nodes, organs, or bones
- PET, a technique under investigation at Memorial Sloan-Kettering, to assess the extent of prostate cancer and particular features of its biology, such as whether it is responsive to hormonal therapy
In some cases, no scans are necessary because the chance that cancer has spread is very low.
Researchers at Memorial Sloan-Kettering are investigating new imaging techniques that would better characterize each individual's cancer -- to gauge how his disease might respond to various treatment modalities and to determine, during treatment, whether and to what extent a specific treatment is effective.
