Gleason score
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2008-07-06T16:16:18Z
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/* References */ Added WHO atlas
[[Image:Gleasonscore2.jpg|thumb|300px|right|'''Gleason score''' Lower scores are associated with small, closely packed glands. Cells spread out and lose glandular architecture as score increases]]
A '''Gleason score''' is given to [[prostate cancer]] based upon its [[microscopic]] appearance. Cancers with a higher Gleason score are more aggressive and have a worse [[prognosis]].
Most often, a urologist will remove a cylindrical sample ([[biopsy]]) of prostate tissue through the rectum, using hollow needles, and prepare microscope slides. After a prostate is removed in surgery, a pathologist will slice the prostate for a final examination.
The pathologist assigns a ''grade'' to the most common tumor, and a second ''grade'' to the next most common tumor. The two ''grades'' are added together to get a Gleason ''score''. For example, if the most common tumor was grade 3, and the next most common tumor was grade 4, the Gleason ''score'' would be 3+4 = 7.
The Gleason ''grade'' ranges from 1 to 5, with 5 having the worst prognosis. The Gleason ''score'' ranges from 2 to 10, with 10 having the worst prognosis.
Gleason scores are associated with the following features:
* Grade 1 - The cancerous prostate closely resembles normal prostate tissue. The glands are small, well-formed, and closely packed
* Grade 2 - The tissue still has well-formed glands, but they are larger and have more tissue between them.
* Grade 3 - The tissue still has recognizable glands, but the [[cell (biology)|cell]]s are darker. At high [[magnification]], some of these cells have left the glands and are beginning to invade the surrounding tissue.
* Grade 4 - The tissue has few recognizable glands. Many cells are invading the surrounding tissue
* Grade 5 - The tissue does not have recognizable glands. There are often just sheets of cells throughout the surrounding tissue.
A [[pathologist]] examines the biopsy specimen and attempts to give a score to the two patterns. First called the primary grade, represents the majority of tumor (has to be greater than 50% of the total pattern seen). Second - a secondary grade - relates to the minority of the tumor (has to be less than 50%, but at least 5%, of the pattern of the total cancer observed). These scores are then added to obtain the final Gleason score. For example, a prostate biopsy specimen may exhibit two different patterns, one which is assigned a number two and the other a number three. The final Gleason score in this case would be five.
The Gleason score is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, the Gleason score is incorporated into a strategy of [[prostate cancer staging]] which predicts prognosis and helps guide therapy.
The scoring system is named after Donald F. Gleason, M.D., a pathologist at the Minneapolis Veterans Affairs Hospital who developed it with other colleagues at that facility in the 1960s. <ref>[http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=325501 Manage Account - Modern Medicine<!-- Bot generated title -->]</ref> It remains an important tool.
==References==
{{reflist}}
*[http://www.medscape.com/viewarticle/406837 Minimal Adenocarcinoma in Prostate Needle Biopsy Tissue,] Phataraporn Thorson, MD, and Peter A. Humphrey, MD, PhD, Am J Clin Pathol 114(6):896-909, 2000. Pathology slides and explanation. [Free]
*[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=13&cat3=749&stype=d WHO, Geneva Foundation for Medical Education and Research, Prostate cancer, Gleason score.] 51 images.
*Gleason DF. ''The Veteran's Administration Cooperative Urologic Research Group: histologic grading and clinical staging of prostatic carcinoma.'' In Tannenbaum M (ed.) Urologic Pathology: The Prostate. Lea and Febiger, Philadelphia, 1977; 171-198.
*[http://www.malecare.com '''Prostate Cancer''' Information website, nonprofit, updated weekly]
[[Category:Histopathology]]
[[Category:Urology]]
[[de:Gleason-Score]]
[[he:מדד גליסון]]
[[ja:グリーソン分類]]
[[pt:Escore de Gleason]]
[[ru:Шкала Глисона]]