Grade Groups of prostate cancer
The Grade Group is the most common system doctors use to grade prostate cancer. It has replaced the Gleason score.
The grade of a cancer tells you how much the cancer cells look like normal cells. This gives your doctor an idea of:
- how aggressive the cancer is
- how it might behave
- whether you need treatment
To find out the Grade Group, a 
looks at several samples of cells from your prostate. These are called biopsies.
How do doctors find out your Grade Group?
The pathologist grades each sample of prostate cancer cells based on how quickly they are likely to grow or how aggressive the cells look. There are 5 Grade Groups. Grade Group 1 is the least aggressive and Grade Group 5 is the most aggressive.
You may also hear about a score called the Gleason score. The Grade Group has now replaced the Gleason grade as doctors think the Grade Group is a more accurate way to grade prostate cancer cells. We have included the Gleason score because people still ask us about this.
The Gleason grade scores each sample of prostate cancer cells from 3 to 5. Doctors work out an overall Gleason score by adding together the 2 most common grades. These might be written separately, for example 3 + 4 = 7. Or as an overall Gleason score of 7.
This is how the Gleason score and Grade Groups match up and what it means:
| Gleason score | Grade Group | What it means |
|---|---|---|
| Gleason score 6 (or 3 + 3 = 6) | Grade Group 1 | The cells look similar to normal prostate cells. The cancer is likely to grow very slowly, if at all |
| Gleason score 7 (or 3 + 4 = 7) | Grade Group 2 | Most cells still look similar to normal prostate cells. The cancer is likely to grow slowly |
| Gleason score 7 (or 4 + 3 = 7) | Grade Group 3 | The cells look less like normal prostate cells. The cancer is likely to grow at a moderate rate |
| Gleason score 8 (or 4 + 4 = 8) | Grade Group 4 | Some cells look abnormal. The cancer might grow quickly or at a moderate rate |
| Gleason score 9 or 10 (or 4 + 5 = 9, 5 + 4 = 9 or 5 + 5 = 10) | Grade Group 5 | The cells look very abnormal. The cancer is likely to grow quickly |
It can be difficult to understand what the Gleason score and Grade Group mean in your situation. Ask your doctor or specialist nurse if you have any questions about this.
Treatment
The Grade Groups are important factors that help your doctor recommend if you need treatment. Doctors also consider the following things:
-
your PSA blood test level
-
the TNM stage of your cancer
If your cancer has not spread, the doctor combines your Grade Group, PSA and TNM stage. They put your cancer into one of the 5 Cambridge Prognostic Groups (CPGs).
Doctors also consider other factors when recommending the best treatment for you:
- How much cancer there is. They base this on the number of
biopsy samples that had cancer divided by the number of biopsies they took. - Your age and general health.
- Whether you have an increased chance of having aggressive cancer. This is based on any
gene changes you might have. - How you feel about what the treatments involve and the side effects.
You might not need treatment straight away. Some prostate cancers are slow growing and might never cause you problems or need treatment. Your doctor might suggest waiting and seeing whether the cancer develops. They monitor your cancer and starts treatment if the cancer begins to grow. Depending on your situation, they may call this active surveillance or watchful waiting.
If your cancer hasn't spread, you might have one of the following treatments:
- surgery to remove your prostate - this is called a prostatectomy
external radiotherapy with or without hormone treatment - internal radiotherapy - this is called
brachytherapy
Treatment as part of a clinical trial
Some treatments are only available as part of a clinical trial. These include:
high intensity focused ultrasound (HIFU) cryotherapy
Your doctor can tell you if one of these treatments might be an option for you.
If your cancer has spread
This is called metastatic prostate cancer. You can read more about the treatment options in the section about metastatic prostate cancer.
Tools to help you decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men who have:
- prostate cancer that hasn't spread
- a Cambridge Prognostic Group (CPG) of 1,2 or 3
The tool can't tell you exactly what is going to happen in the future. But it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large cancer.
To be able to use the tool you need to know the following about your cancer:
-
PSA level
-
T stage of your cancer
-
the Grade Group
-
how much cancer there is - this is based on the number of biopsy samples that contained cancer divided by the number of biopsies taken
Speak to your doctor if you want to find out more about this or if you need help using the tool. There is a video explaining what the tool is about. The video is 1 minute and 46 seconds long.
