After a prostate biopsy, men receive a report with numbers such as Gleason 3+4 or grade group 2. These numbers are the most important part of the report because they show how aggressive the tumour is and help choose treatment. This page explains them simply, but your own report should be interpreted with your doctor.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed:
What is the Gleason score?
The pathologist looks at the tumour cells and gives each pattern a number from 3 to 5 according to how different it looks from normal cells. The number of the most common pattern is added to the second most common, giving a score from 6 to 10. That is why 3+4 differs from 4+3 even though both total 7.
Grade groups (ISUP)
| Grade group | Gleason score | Meaning |
|---|---|---|
| 1 | 6 (3+3) | Low grade, usually slow-growing |
| 2 | 7 (3+4) | Intermediate, mostly the less aggressive pattern |
| 3 | 7 (4+3) | Intermediate, mostly the more aggressive pattern |
| 4 | 8 | High grade |
| 5 | 9 or 10 | High grade |
What else is in the report?
- The number of positive cores out of the total, and the percentage of tumour in each.
- Perineural invasion inside the prostate.
- Special patterns such as cribriform pattern, which can affect decisions even with an intermediate grade.
How is the grade used?
European guidelines combine the grade with PSA and examination findings to place men into risk groups:
- Low risk: PSA below 10, grade group 1 and limited tumour. Active surveillance usually suits.
- Intermediate risk: PSA 10 to 20, or grade group 2 or 3. Surveillance for selected cases, surgery or radiotherapy are discussed.
- High risk: PSA above 20, grade group 4 or 5, or a larger tumour. Tests for spread and active treatment are needed.
MRI and PI-RADS
A multiparametric MRI is usually done before biopsy and scored with PI-RADS from 1 to 5. Scores of 4 and 5 mean a high chance of significant cancer and are sampled with a targeted biopsy.
Questions to ask your doctor
- What are my grade group and risk group?
- Is active surveillance suitable for me?
- Do I need tests for spread?
- What are the benefits and side effects of each option?
Related topics
Frequently asked questions
What does Gleason 6 mean?
Gleason 6 (3+3) is the lowest cancer grade reported today and equals grade group 1. It usually grows slowly, and many men with it are suited to active surveillance rather than immediate treatment.
What is the difference between Gleason 3+4 and 4+3?
Both add up to 7, but the first number is the most common pattern in the tumour. So 3+4 (grade group 2) is less aggressive than 4+3 (grade group 3).
Is Gleason 8 serious?
Gleason 8 to 10 (grade groups 4 and 5) means a high-grade tumour, which usually needs tests for spread and active treatment; the doctor discusses options according to stage.
What is PI-RADS on MRI?
A 1 to 5 scale of how likely MRI findings are to be significant cancer. 1 and 2 are low, 3 is uncertain, and 4 and 5 are high and usually lead to a biopsy.
Can the Gleason score change?
Yes. The biopsy grade can be lower or higher than the final grade after prostatectomy, because a biopsy samples only small parts. In active surveillance a repeat biopsy is sometimes done to confirm.
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Prof. Al-Samarrai and Dr. Amer Mousa assess prostate biopsy and MRI results and explain the options at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
This information is for health education and does not replace a medical examination. See our medical content policy.