As you navigate a prostate cancer diagnosis, you’ll likely hear a lot about your Gleason score. This medical term refers to a grading system that helps doctors determine whether you have prostate cancer, how aggressive it may be, and when treatment should begin.

Understanding how your Gleason score is determined—and why a score of 7 can be pivotal for many men—can help you better communicate with your doctor and feel more informed about your care. 

Get our guide for newly diagnosed prostate cancer patients. 

What is the Gleason Score?

A Gleason score is a number used to determine how abnormal cancer cells look compared to normal cells in the prostate. You receive this score after a prostate biopsy, and it can be found on your pathology report.

During a biopsy, tissue samples are taken from several areas of the prostate and examined under a microscope. The two most common cell patterns found in the samples are each assigned a number on a scale of 1 to 5. A score of 1 means the cells look more like healthy cells, while a score of 5 means the cells appear more aggressive and cancerous. Scores in between fall somewhere along the scale.

These two numbers are added together, with the number from the most predominant cell pattern listed first in the equation. The total is your Gleason score.

If your Gleason score is 6 or lower, it generally means the cancer is slow growing or less likely to spread. However, a Gleason score of 7 or higher may signal a greater chance that the cancer could grow or spread.

Why is the Gleason Score Important for Prostate Cancer Patients?

 The Gleason score is often used to help determine when it’s time to start prostate cancer treatment. When prostate cancer is caught early through regular screening, treatment may not be recommended right away. Instead, the cancer may be monitored closely through regular follow-up tests, delaying treatment until the cancer begins to progress. For some men, this can take years. Others may never need treatment at all.  

In general, a Gleason score higher than 7 may indicate that it’s time to begin treatment. However, when the score is exactly 7, the decision is more complex.

Learn more about Gleason scores and prostate cancer staging here.

A Gleason Score of 7: Why the First Number Matters

A Gleason score of 7 typically describes cancer cells that still look somewhat similar to healthy cells. These are called “well differentiated” cells, meaning they still have some of the organization and structure of normal cells. A Gleason score of 7 is generally considered a medium-grade cancer with an intermediate risk of growing or spreading. However, decisions about treatment often depend on which number appears first in the equation.

As a reminder, the Gleason score is based on the two most common cell patterns in the prostate biopsy samples, with the most predominant pattern listed first. A score of 7 could come from adding 3 + 4 or 4 + 3.

In general, men with a Gleason score of 4 + 3 are more likely to begin treatment sooner. That’s because the predominant cell pattern is considered more aggressive compared to a score of 3 + 4, where the majority of cells still look more similar to healthy cells. In this case, men might be able to wait longer before treatment needs to begin.

Every prostate cancer diagnosis is unique, and the prognosis depends on many factors, including your overall health. For men with a Gleason score of 7, prostate cancer is still considered relatively low-grade and often very treatable. Many men live for years—or even decades—after diagnosis.

Treatment Options When Your Gleason Score is 7

If your  Gleason score is 7, your doctor will consider a number of different treatment approaches based on your unique situation. Some common treatment options at this stage may include active surveillance, radiation therapy, hormone therapy, and (less often) surgery.

Your RMCC prostate cancer care team will work with you to create a recommended treatment plan, which may include:

Active surveillance

Active surveillance means that instead of beginning treatment right away, your doctor will monitor the cancer closely to make sure it’s not progressing. Oftentimes, this involves getting a PSA blood test every six months and a digital rectal exam once a year. You may also need periodic biopsies to check whether your Gleason score has changed.

This approach allows your oncologist to keep a close eye on your cancer and begin treatment if there are signs it is progressing. If the cancer remains stable, you may be able to safely delay treatment.

Radiation therapy for prostate cancer

Radiation therapy is an effective prostate cancer treatment approach for many men, 

including those with a Gleason score of 7. It can be used to treat prostate cancer at a variety of stages. Radiation therapy may be delivered internally, externally, or through a combination of both types.

Brachytherapy, also called seed therapy, is a form of internal radiation. During this procedure, the oncologist implants small radioactive “seeds” or pellets into the prostate, which target and kill cancer cells over time.

External beam radiation therapy uses high-energy particles or rays to destroy cancer cells from outside the body. Treatment is delivered using a large machine called a linear accelerator. The accelerator delivers very carefully directed beams of radiation to the area of the cancer. Because the prostate is located near several organs, including the rectum and bladder, additional technology may be used to help protect these areas and reduce potential side effects.

External radiation treatments are usually performed in a hospital or clinic five days per week for several weeks.

Hormone therapy to slow prostate cancer from growing

Because male hormones, called androgens, can cause prostate cancer to grow, hormone therapy is used to reduce or block these hormones. Most often, this is done with medications that slow or stop them from being produced by the testicles. This, in turn, slows the growth of the cancer. In some cases, surgery to remove the testicles may also be used to stop hormone production, although this approach is less common today.

Prostatectomy: Surgery to remove the prostate

Surgical removal of the prostate gland, called a prostatectomy, is sometimes recommended for prostate cancer that has not spread outside the prostate gland. However, this approach can come with permanent side effects that can affect urinary or sexual function. Your doctor can help you understand the potential benefits and risks of surgery, as well as discuss whether other treatment approaches may be an option for you.

Read our blog: Treating Prostate Cancer: Know Your Options Beyond Surgery

Treatment for Advanced Stage Prostate Cancer

 More advanced stages of prostate cancer, including cancers with a Gleason score higher than 7 or prostate cancer that has returned after treatment, may require different treatment approaches. One newer option is prostate-specific membrane antigen or PSMA Therapy, which uses advanced diagnostic imaging technology to pinpoint prostate cancer cells and then deliver targeted treatment to destroy them. 

Choosing the Right Treatment Plan for You

If you’ve been diagnosed with prostate cancer, the best treatment approach for you depends on many factors, including your age, overall health, and the stage and characteristics of your cancer.

To help you make informed decisions about your care, it’s helpful to meet with both an oncologist as well as your urologist to review your treatment options. At RMCC, our medical oncologists specialize in prostate cancer care and are available to talk with you about the treatment plan that’s right for you.

Follow-up and Ongoing Management for Prostate Cancer

If you are in active surveillance, it’s important to see your oncologist regularly so your cancer can be closely monitored. Your doctor may also recommend repeat biopsies, if needed, to determine whether your Gleason score has changed. Ongoing coordination with your cancer care team can help guide the best next steps for your treatment.

If you’ve recently completed treatment for prostate cancer, regular follow-up appointments are also important. Your care team will monitor your health for any signs that the cancer may have returned. Catching it early can provide the best chance for timely treatment and management.

If you were recently diagnosed with prostate cancer and would like to learn more about your treatment options, download our free guide.  You can also schedule an appointment with one of our Colorado-based prostate cancer specialists. They can review your options and help you and your loved ones make informed decisions about your care.