Prostate cancer diagnosis: What a Gleason score of 9 really means

Prostate cancer: The Gleason score helps predict how quickly a prostate tumour might grow. A score of 6 is low-grade, 7 is intermediate, and 8 to 10 is high-grade (Image: Canva)

Former US president Joe Biden was recently diagnosed with prostate cancer, marked by a Gleason score of 9, one of the most serious classifications for this disease. According to the American Cancer Society (ACS), cancers with Gleason scores of 8 to 10 are considered high-grade or poorly differentiated, meaning they are more likely to grow and spread quickly.

The vast majority of prostate cancers, including likely Biden’s, are adenocarcinomas, which means cancers that start in gland cells. Less common types such as small cell carcinoma have different behaviours and treatments.

Pathology reports matter:

Also read | Aggressive prostate cancer: Causes, symptoms, risk factors and prevention tips

These reports include not only the Gleason score but also features like perineural invasion (cancer near nerves) or intraductal carcinoma. These can influence treatment choices and outlook. While prostatitis (inflammation) can raise PSA levels, it is not linked to cancer. If inflammation is found alongside cancer, it doesn’t change the diagnosis or treatment.

Understanding the diagnosis:

Prostate cancer is diagnosed through a biopsy, where small samples, called cores, are taken from different areas of the prostate using a thin, hollow needle. These cores are examined under a microscope by a pathologist, who assigns a grade based on how abnormal the cells appear. The two most prevalent patterns are graded from 3 to 5, then added together to form the Gleason score. A score of 9 usually indicates a combination of two aggressive patterns, such as 4 + 5 or 5 + 4.

Also read | Prostate cancer in men: Early detection through symptoms, diagnosis

Here’s what you need to know

What is a Gleason score: The Gleason score helps predict how quickly a prostate tumour might grow. A score of 6 is low-grade, 7 is intermediate, and 8 to 10 is high-grade. A score of 9 falls into Grade Group 5, the highest category, and signals an aggressive cancer.

Collecting biopsy samples: Doctors typically remove 10–12 cores from different prostate regions. Each is assessed individually for cancer. Not every core may show cancer, and the Gleason score is often based on the highest-grade core found. According to the ACS, high-grade cancers like Gleason 9 are more likely to spread. Treatment often involves surgery, radiation, and hormone therapy, depending on how far the cancer has progressed.

Using grade groups: To simplify Gleason scores, cancers are grouped from 1 to 5. Grade Group 5, where Gleason 9 fits, indicates the most aggressive disease. This system helps doctors guide treatment decisions more clearly.

Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis.