NCCN Guidelines for Patients® | Prostate Cancer

18 NCCN Guidelines for Patients ® : Prostate Cancer, 2018 2  Cancer staging Gleason score Prostate biopsies often occur with no problems. However, side effects are possible. Some people have allergic reactions to anesthesia. Tell your doctor if you’ve had any problems with anesthesia in the past. The prostate biopsy may cause: Often † † Blood in your semen (hematospermia) or urine (hematuria) † † Rectal bleeding Sometimes † † Infection Rarely † † Swelling of your prostate (prostatitis) or epididymis (epididymitis) † † Inability to empty your bladder (urinary retention) † † Require an overnight stay in the hospital Gleason score One grading system for prostate cancer is called the Gleason score. The Gleason score is used by doctors to plan treatment. Results from the biopsy are used for scoring. First, the cancer is assigned two Gleason grades. The primary grade is the most common Gleason pattern. The secondary grade is the second most common Gleason pattern. Gleason grades are depicted in Figure 5 . Glands comprised of cells with a grade of 1 or 2 may not be able to be scored on a prostate biopsy. Therefore, Gleason grades range from 3 for glands made of cancer cells that look almost normal to 5 for very abnormal cells that aren’t able to form glands. The primary and secondary grades are added together to get the Gleason score. Gleason scores range from 2 to 10, but most prostate cancers are scored 6 to 10. Guide 1 briefly describes what the scores mean. Higher Gleason scores mean the cancer is more likely to grow and spread. Another factor used in regard to the Gleason score is Grade Groups. The Gleason scores have been divided into groups ranging from 1 to 5. The Gleason score and Gleason pattern determine the group. Doctors use Gleason scores and groups to select the most appropriate treatment. Grade Group † † 1 is Gleason score =6 and Gleason pattern =3+3 † † 2 is Gleason score 7 and Gleason pattern 3+4 † † 3 is Gleason score 7 and Gleason pattern 4+3 † † 4 is Gleason score 8 and Gleason pattern 4+4, 3+5, 5+3 † † 5 is Gleason score 9 or 10 and Gleason pattern 4+5, 5+4, 5+5