What Does a Gleason Score of 7 Mean? (3+4 vs 4+3)

This page is for men told their prostate biopsy shows a Gleason score of 7. It explains how the score is built, why 3+4 and 4+3 differ, and what questions to ask.

A Gleason score is not a single measurement. NCI explains that a pathologist (a doctor who studies tissue) looks at the prostate tissue samples to find the two main cell patterns, and grades each one.

The primary pattern is the most common tissue pattern. The secondary pattern is the next most common. Each is given a grade from 3 to 5. Grade 3 looks the most like normal prostate tissue and grade 5 looks the most abnormal. The two grades are added together to produce the score.

That is why a 7 is always written as a sum. NCI gives the format 3+4=7 as an example.

NCI states the Gleason score can range from 6 to 10, and that the higher the score, the more likely the cancer will grow and spread quickly.

• 6 — described by NCI as a low-grade cancer.
• 7 — described by NCI as a medium-grade cancer.
• 8, 9 or 10 — described by NCI as high-grade cancer.

A 7 is the middle of the range that NCI describes. It is neither the lowest grade the scale produces nor the highest.

One caution about material you may find online. In the staging section of the same NCI summary, the Gleason score is described as ranging from 2 to 10. The general information section gives the range as 6 to 10. If you see a different range quoted, ask your team how it applies to your report.

This is the part that a total of "7" hides, and it is usually what people want to know.

Because the first number is the primary pattern, the order tells you which pattern makes up most of what the pathologist saw. NCI gives this example directly: if the most common tissue pattern is grade 3 and the secondary pattern is grade 4, most of the cancer is grade 3 and less of it is grade 4. The grades are added for a Gleason score of 7.

Reverse the order and you reverse which pattern dominates.

NCI states that Grade Group 2 or 3 is a Gleason score of 7. A Gleason 7 does not map to a single Grade Group. It splits into two, and your report will say which one applies to you. That split is the formal way the difference between the two arrangements is recorded.

If your report says only "Gleason 7" without the two numbers or a Grade Group, that is a reasonable thing to ask about. The fuller version is standard.

It is easy to treat the Gleason score as the whole answer. NCI does not.

For staging, NCI states that the Grade Group and PSA level are used together. The Grade Groups map as follows:

• Grade Group 1 — Gleason score of 6 or less
• Grade Group 2 or 3 — Gleason score of 7
• Grade Group 4 — Gleason score of 8
• Grade Group 5 — Gleason score of 9 or 10

For prognosis (the likely outcome) and treatment options, NCI lists three things:

• the stage of the cancer (level of PSA, Gleason score, Grade Group, how much of the prostate is affected, and whether the cancer has spread)
• the patient's age
• whether the cancer is newly diagnosed or has recurred

Treatment options may also depend on other health problems, expected side effects, past treatment, and the wishes of the patient.

So a number on its own does not determine what happens next, and two people with the same Gleason 7 can reasonably be offered different options.

It will not tell you what your score means for your outcome. That depends on the combination above, on findings this page cannot see, and on decisions that belong to you and your care team.

NCI does note, in general terms, that most men diagnosed with prostate cancer do not die of it. That is a statement about a large group of people, not a prediction about any individual, and it is not a substitute for the conversation your report should start.

• Is my score written as 3+4 or 4+3, and which Grade Group does my report state?
• What was my PSA level at diagnosis?
• How many cores were taken, how many contained cancer, and what percentage of each?
• Was the biopsy MRI-guided, and were prior images compared?
• Has a second pathologist reviewed the slides?
• Is active surveillance (close monitoring instead of immediate treatment) among the reasonable options in my situation, and what would prompt a change?

See What Does a Gleason Score Mean?, Understanding Gleason Scores and Grade Groups, and Getting a Second Opinion.

• https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq