What Does a Gleason Score of 8 Mean?

This page is for men told their prostate biopsy shows a Gleason score of 8. It explains what the number describes, what "high grade" does and does not mean, and what to ask.

A Gleason score adds two pattern grades. NCI explains that the pathologist (a doctor who studies tissue) finds the two main cell patterns in the tissue, grades each from 3 to 5, and adds them. Grade 3 looks the most like normal prostate tissue. Grade 5 looks the most abnormal.

An 8 can be reached in more than one way, for example 4+4, 3+5, or 5+3. Your report should show the two numbers, not just the total. NCI gives 3+4=7 as an example of how the two numbers are written.

If your report shows only "Gleason 8", asking for the two component patterns is reasonable.

NCI groups the scores plainly:

• 6 — low-grade cancer
• 7 — medium-grade cancer
• 8, 9 or 10 — high-grade cancer

NCI states that the higher the Gleason score, the more likely the cancer will grow and spread quickly.

NCI maps a Gleason score of 8 to Grade Group 4. Grade Group 5 covers scores of 9 or 10, so an 8 sits at the lower end of the high-grade range rather than the top of it.

High grade is a description of how the cells look under a microscope and how quickly the cancer is likely to grow and spread. That is NCI's definition of grade.

It is not, on its own, a statement about where the cancer is, whether it has spread, or what will happen. NCI is explicit that staging is a separate process. It is used to find out if cancer cells have spread within the prostate or to other parts of the body. NCI adds that the Grade Group and PSA level are used together to stage prostate cancer.

NCI also notes that in prostate cancer, staging tests may not be done unless there are symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score. A high grade is one of the things that can prompt further staging tests, so it is reasonable to ask whether any are planned in your case.

• The stage of the cancer: PSA level, 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

For treatment options specifically, NCI adds:

• whether the patient has other health problems
• the expected side effects of treatment
• past treatment for prostate cancer
• the wishes of the patient

That last item is on NCI's list, and it belongs there. A grade does not decide for you.

You may have arrived here having typed your own score into a search box, wanting to know what it means for you. This page cannot tell you that, and any page that claims to from the number alone is overreaching.

What it can tell you is what the number describes, what it is combined with, and which questions get you a real answer from the people who can see your whole picture.

• What are the two pattern numbers behind my 8, and does my report state Grade Group 4?
• What was my PSA level at diagnosis?
• Are staging tests planned? NCI lists bone scan, MRI, CT, pelvic lymphadenectomy (removing lymph nodes in the pelvis) and seminal vesicle biopsy among those used in staging.
• How many cores were taken, how many had cancer, and what percentage of each?
• Has a second pathologist reviewed the slides?
• Will my case be reviewed by a multidisciplinary team (specialists from different fields), and can I get a second opinion before deciding?

See What Does a Gleason Score Mean?, What Does a Gleason Score of 7 Mean?, and Getting a Second Opinion.

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