{"entity":{"id":"gleason-grade-group","kind":"term","name":"Gleason score / Grade Group","aka":["Gleason","Gleason score","Gleason grade","Grade Group","ISUP grade","Gleason 6","Gleason 7","3+4","4+3","grade groups","gleason","grade group","ISUP grade group","WHO grade group","GG1","GG2","GG3","GG4","GG5","Gleason 3+3","Gleason 8","Gleason 9","Gleason 10"],"tldr":"The pathologist's 1-to-5 grade of how abnormal prostate cancer looks, which drives most treatment decisions.","summary":"The Gleason score is the pathologist's grade of how abnormal prostate cancer looks under the microscope: patterns graded 3 to 5 are summed to give a score from 6 to 10, which is then mapped to ISUP Grade Groups 1 to 5. Grade Group 1, corresponding to Gleason 6, is now managed by active surveillance rather than immediate treatment, while cribriform and intraductal patterns carry extra risk within a grade. Because the grade drives most treatment decisions, it is central to the overdiagnosis bottleneck and to PSA and MRI-first screening, and it is the baseline to which gene-expression tests such as Prolaris and the Oncotype DX Genomic Prostate Score add information. AI graders such as Paige and ArteraAI, part of digital pathology, reduce variation between observers.","asOf":"2026-09-06","wikipedia":"https://en.wikipedia.org/wiki/Gleason_grading_system","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Gleason_grading_system"},{"label":"Royal College of Pathologists G084: dataset for histopathology reports for prostatic carcinoma, version 4, October 2024","url":"https://www.rcpath.org/static/8cc88604-2c8d-4df4-a99542df41c102af/G084-dataset-for-histopathology-reports-for-prostatic-carcinoma.pdf"},{"label":"Epstein et al., American Journal of Surgical Pathology 2016: the 2014 ISUP consensus conference on Gleason grading, and the grade group system","url":"https://doi.org/10.1097/PAS.0000000000000530"},{"label":"NICE NG131: prostate cancer, diagnosis and management","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations"}],"tags":[],"related":["tumour-differentiation","active-surveillance","prostatectomy","adt"],"cancers":["prostate"],"sections":["diagnostics"],"technologies":["digital-pathology-ai","active-surveillance"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["percentage-gleason-pattern-4","cribriform-prostate-cancer","intraductal-carcinoma-prostate","cambridge-prognostic-group"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["What a UK report actually carries in 2026. Both scales, together. The Royal College of Pathologists dataset in force (G084, version 4, October 2024) sets out the grade groups to be used 'in tangent with the Gleason score', and its reporting proforma asks for the Gleason score and the grade group as separate items. Grade group 1 is Gleason 6 or less, only individual discrete well-formed glands; group 2 is 3+4=7; group 3 is 4+3=7; group 4 is Gleason 8, which is 4+4, 3+5 or 5+3; group 5 is Gleason 9 to 10. A report that gives only one of the two is unusual, and the Gleason score is the one that will appear in older notes and in the Cambridge Prognostic Group table.","Two core items the 2024 UK dataset added beside the grade. In core biopsies the report must give the percentage of Gleason pattern 4, and it must state whether intraductal carcinoma or invasive cribriform carcinoma is present. Both change what should happen next: the percentage separates two men who were both told grade group 2, and either pattern argues against active surveillance and triggers an offer of germline genetic testing.","Why the grade group system was invented at all. To split Gleason 7. Gleason score 7 had been treated as one group in study after study when it is plainly two, 3+4 and 4+3, with different outcomes; the grade groups separate them as groups 2 and 3, and NICE's Cambridge Prognostic Groups use exactly that split to separate CPG 2 from CPG 3. Favourable and unfavourable intermediate risk is the NCCN's language, not NICE's; the Cambridge table has no such labels.","NICE NG131 (1.2.15, table 1) builds the five Cambridge Prognostic Groups from the grade group, the PSA and the T stage: CPG 1 is grade group 1 with PSA below 10 and stage T1 to T2; CPG 2 is grade group 2 or PSA 10 to 20 at T1 to T2; CPG 3 is grade group 2 together with PSA 10 to 20, or grade group 3, at T1 to T2; CPG 4 is one of grade group 4, PSA above 20 or stage T3; CPG 5 is two or more of those, or grade group 5, or stage T4. Every treatment recommendation in the localised section is written against one of those five numbers."],"category":"Clinical"},"route":"/terms/gleason-grade-group/","neighbours":{"term":[{"id":"prostate-acinar-adenocarcinoma","kind":"term","name":"Acinar adenocarcinoma of the prostate","route":"/terms/prostate-acinar-adenocarcinoma/"},{"id":"active-surveillance-term","kind":"term","name":"Active surveillance and observation","route":"/terms/active-surveillance-term/"},{"id":"adt","kind":"term","name":"Androgen deprivation therapy (ADT)","route":"/terms/adt/"},{"id":"cambridge-prognostic-group","kind":"term","name":"Cambridge Prognostic Group (CPG 1 to 5)","route":"/terms/cambridge-prognostic-group/"},{"id":"prostate-treatment-choice-localised","kind":"term","name":"Choosing treatment for localised prostate cancer: what each option costs","route":"/terms/prostate-treatment-choice-localised/"},{"id":"cribriform-prostate-cancer","kind":"term","name":"Cribriform growth pattern in prostate cancer","route":"/terms/cribriform-prostate-cancer/"},{"id":"staging-systems","kind":"term","name":"Disease-specific staging and risk systems (FIGO, Ann Arbor, IPI, R-ISS, ELN, IMDC)","route":"/terms/staging-systems/"},{"id":"prostate-focal-therapy","kind":"term","name":"Focal and tissue-preserving treatment of prostate cancer","route":"/terms/prostate-focal-therapy/"},{"id":"intraductal-carcinoma-prostate","kind":"term","name":"Intraductal carcinoma of the prostate (IDC-P)","route":"/terms/intraductal-carcinoma-prostate/"},{"id":"neuroendocrine-differentiation","kind":"term","name":"Neuroendocrine differentiation in prostate cancer","route":"/terms/neuroendocrine-differentiation/"},{"id":"overtreatment","kind":"term","name":"Overtreatment","route":"/terms/overtreatment/"},{"id":"percentage-gleason-pattern-4","kind":"term","name":"Percentage of Gleason pattern 4","route":"/terms/percentage-gleason-pattern-4/"},{"id":"pi-rads","kind":"term","name":"PI-RADS (Prostate Imaging Reporting and Data System)","route":"/terms/pi-rads/"},{"id":"psa-kinetics","kind":"term","name":"PSA kinetics: PSA doubling time and PSA density","route":"/terms/psa-kinetics/"},{"id":"prostatectomy","kind":"term","name":"Radical prostatectomy","route":"/terms/prostatectomy/"},{"id":"template-mapping-biopsy","kind":"term","name":"Template mapping biopsy (transperineal template prostate mapping)","route":"/terms/template-mapping-biopsy/"},{"id":"tnm-prostate-cancer","kind":"term","name":"TNM staging for prostate cancer, and what changed in the 9th edition","route":"/terms/tnm-prostate-cancer/"},{"id":"tumour-differentiation","kind":"term","name":"Tumour differentiation (well / moderately / poorly differentiated)","route":"/terms/tumour-differentiation/"},{"id":"whole-mount-pathology","kind":"term","name":"Whole-mount pathology","route":"/terms/whole-mount-pathology/"}],"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"},{"id":"digital-pathology-ai","kind":"technology","name":"Digital pathology & AI","route":"/technologies/digital-pathology-ai/"},{"id":"prostate-screening-psa-mri","kind":"technology","name":"PSA and MRI-first prostate cancer screening","route":"/technologies/prostate-screening-psa-mri/"}],"cancer":[{"id":"prostate-ductal-adenocarcinoma","kind":"cancer","name":"Ductal adenocarcinoma of the prostate","route":"/cancers/prostate-ductal-adenocarcinoma/"},{"id":"prostate-intermediate-risk","kind":"cancer","name":"Localised prostate cancer, intermediate risk","route":"/cancers/prostate-intermediate-risk/"},{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}],"paper":[{"id":"paper-johnson-mpmri-individual-foci-eur-urol-2019","kind":"paper","name":"Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging","route":"/key-papers/paper-johnson-mpmri-individual-foci-eur-urol-2019/"},{"id":"paper-castro-germline-brca-prostate-outcomes-jco-2013","kind":"paper","name":"Germline BRCA mutations are associated with higher risk of nodal involvement, distant metastasis and poor survival outcomes in prostate cancer","route":"/key-papers/paper-castro-germline-brca-prostate-outcomes-jco-2013/"},{"id":"paper-taylor-integrative-genomic-profiling-cancer-cell-2010","kind":"paper","name":"Integrative genomic profiling of human prostate cancer","route":"/key-papers/paper-taylor-integrative-genomic-profiling-cancer-cell-2010/"},{"id":"paper-guedes-msh2-loss-primary-prostate-ccr-2017","kind":"paper","name":"MSH2 loss in primary prostate 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cancer","route":"/key-papers/paper-tcga-molecular-taxonomy-primary-prostate-cell-2015/"}],"idea":[{"id":"idea-prostate-per-lesion-mri-audit-before-focal-treatment","kind":"idea","name":"Publish a per-lesion miss rate for every prostate MRI service before it is allowed to guide focal treatment","route":"/ideas/idea-prostate-per-lesion-mri-audit-before-focal-treatment/"}],"trial":[{"id":"rtog-0521","kind":"trial","name":"NRG Oncology RTOG 0521","route":"/trials/rtog-0521/"},{"id":"rtog-9202","kind":"trial","name":"RTOG 92-02","route":"/trials/rtog-9202/"},{"id":"spcg-4","kind":"trial","name":"SPCG-4 (Scandinavian Prostate Cancer Group Study 4)","route":"/trials/spcg-4/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"drug":[{"id":"oncotype-dx-gps","kind":"drug","name":"Oncotype DX Genomic Prostate Score","route":"/drugs/oncotype-dx-gps/"},{"id":"prolaris","kind":"drug","name":"Prolaris","route":"/drugs/prolaris/"}]}}