A Gleason Score of 7: Why is it So Important?

6 min read


A Gleason Score of 7: Why is it So Important?

Navigating a prostate cancer diagnosis often comes with learning medical terms that you probably never heard before! For prostate cancer, the Gleason score is one of those terms. The Gleason score helps with determining whether cancer is present and, if it is when to start treatments. Let’s look at how this score is determined and why a score of 7 is such a pivotal point for many men. Get our guide for newly diagnosed prostate cancer patients. 

What is the Gleason Score?

A Gleason score is listed as a part of the report from the prostate biopsy called a pathology report. There are samples of tissue taken from a few places in the prostate which are then examined under a microscope. The two most predominant cell patterns found in the tested samples are assigned a number between 1 and 5. A score of 1 means the cells are healthy. A score of 5 means the cells are cancerous. A number in between means the cell pattern is somewhere between normal and cancerous. 

These two numbers are added together to create the Gleason score. The most predominant cell pattern’s score is put first in the equation. This is important to note! Anything under 6 means there is no cancer. However, a Gleason score of 7 can be from adding 3+4 or 4+3. 

Why is the Gleason Score Important for Prostate Cancer Patients?

The Gleason score is often an indicator of whether it’s time to start prostate cancer treatment. When prostate cancer is caught early from regular screening, treatment isn’t always recommended right away. These men can often monitor the cancer closely through regular follow-up tests, avoiding the side effects that can come with treatment until the cancer has started to progress. This can take years for some men!

Alternatively, if the Gleason score is higher than 7 it’s most likely time to begin treatments. But for men with a score of 7, it’s how they arrive at the score that plays a role in whether treatments should begin.

Learn more about Gleason scores and prostate cancer staging here. 

A Gleason Score of 7: Look at Which Number is First

A Gleason score of 7 is described as follows: the cells look similar to healthy cells, and they are well differentiated. This is considered a medium-grade cancer with an intermediate risk. However, the decision on whether it might be time to start treatment is closely tied to which number came first in the equation.

A Gleason score of 7 could come from adding 3 + 4 or from adding 4 + 3.  Patients with a Gleason score of  4 + 3 are more likely to begin treatment now. A 3 + 4 means that the predominant cell pattern is closer to healthy cells and you may be able to wait a bit longer before treatment needs to begin. 

Every cancer diagnosis is a little different, and the prognosis will vary depending on several factors, including your overall health. Prostate cancer, with a Gleason score of 7, is generally considered to have a positive outlook. Gleason scores of 7 are still considered relatively low-grade and rarely result in death within ten years of diagnosis. 

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Treatment Options When Your Gleason Score is 7

Treatment approaches will vary depending on your unique situation. Some common treatment approaches that may be used for prostate cancer with a Gleason score of 7 include active surveillance, radiation therapy, and hormone therapy. 

Surgery is sometimes recommended for prostate cancer treatment, so we have included it on this list. However, it can usually be avoided when the cancer is found early. A prostate cancer oncologist will be able to talk through a recommended plan for you.

Active surveillance

Active surveillance means that instead of starting any treatment methods, you will simply visit your doctor frequently to ensure that the cancer is not progressing. You can expect to see your doctor about once every six months for a PSA blood test and once a year for a digital rectal exam. They are likely to repeat the biopsy every so often to see if the Gleason score has changed.

This method allows your oncologist to keep a close eye on your cancer so that treatment can be started right away if your cancer does start to progress. If it does not progress, then you can wait to start treatment. 

Radiation therapy for prostate cancer

One effective prostate cancer treatment approach that has been found to work particularly well for men with a Gleason score of 7 is radiation therapy. However, this treatment method can be used for prostate cancer that is in any stage. Radiation therapy for prostate cancer can be internal or external. Some patients receive both types.

Brachytherapy (aka seed therapy) is internal radiation. The oncologist will implant small “seeds” or pellets of radiation into the prostate. They break down on their own over time while killing cancer cells in the prostate.

External beam radiation therapy works by using high-energy particles or rays to kill cancer cells. The patient lies under a machine called a linear accelerator which delivers very carefully directed beams of radiation to the area where the cancer is located. Because there are several other vital organs in the area including the rectum and bladder, there is sometimes additional technology used to protect these organs from the radiation and the side effects that can occur.

External radiation is delivered from outside of the body using a large machine. You will have to go to the hospital or a clinic for treatment about five days per week for a few weeks. 

Hormone therapy to slow prostate cancer from growing

Because male hormones, or androgens, can cause prostate cancer to grow, hormone therapy uses drugs or surgery to block them. Most often this can be achieved with hormone therapy drugs that slow or stop the male androgens from being produced by the testicles. This in turn slows the growth of the cancer. Surgery to remove the testicles is another way to stop the production of male hormones. This is not used as often as drug therapies. 

Prostatectomy: Surgery to remove the prostate

Surgical removal of the prostate gland is sometimes recommended for prostate cancer that is confined to the prostate gland only. However, this can come with permanent side effects that can affect you and your partner. Surgery can often be avoided by seeing an oncologist and using other treatment approaches.  

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

Treatment for Advanced Stage Prostate Cancer

More advanced stages of prostate cancer (Gleason score higher than 7), or prostate cancer that has recurred, may have different treatment options available including PSMA Therapy, a recently launched treatment for some patients that uses diagnostic imaging technology with a therapy recently approved by the US Food and Drug Administration that targets and destroys prostate cancer cells.

Choosing the Right Treatment Plan for You

The right treatment for each patient varies depending on your stage, age, overall health, and the specific details of your cancer diagnosis. Considering these factors, it’s best to see an oncologist in addition to a urologist to review treatment options. It’s not always necessary to have surgery, at least not right away. 

Follow-up and Ongoing Management for Prostate Cancer

It's important to visit your oncologist regularly, especially if you are in active surveillance so they can monitor your cancer and pay attention to whether it’s time to begin a particular treatment regimen. You may need to have a repeat biopsy where your Gleason score can change, which will give the cancer care team direction for the best next steps. 

If you recently completed treatment be sure you continue to see your oncology team for follow-up appointments. If they notice the cancer is coming back they have the best chance of slowing the growth by finding it as soon as possible.

If you were recently diagnosed with prostate cancer and would like to look at your treatment options, download our free guide. You can also schedule an appointment with one of our Colorado prostate cancer specialists. They will review your options for treatment so you and your loved ones can make the decision that’s best for you. 

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Austin Poole, MD

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Allen L. Cohn, MD

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