What Does a Gleason Score of 9 or 10 Mean?

A Gleason score adds two pattern grades, each from 3 to 5. NCI explains that grade 3 looks the most like normal prostate tissue and grade 5 looks the most abnormal, and that the primary pattern is the most common one seen.

A 9 is 4+5 or 5+4. A 10 is 5+5.

NCI groups them together: Grade Group 5 is a Gleason score of 9 or 10. That is why this page covers both. In the grouping NCI uses for staging, they are not separated.

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

NCI states the higher the Gleason score, the more likely the cancer will grow and spread quickly. Grade Group 4 is a Gleason 8; Grade Group 5 covers 9 and 10 and is the highest group.

NCI notes that in prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread. NCI lists a high Gleason score as one of those prompts, alongside bone pain and a high PSA level.

So if more tests are being arranged, that is consistent with what NCI describes rather than a sign that something extra has gone wrong. NCI lists these among the tests and procedures that may be used in staging:

• Bone scan — checks for rapidly dividing cells in the bone
• MRI — detailed pictures using a magnet, radio waves and a computer
• CT scan — detailed pictures from different angles
• Pelvic lymphadenectomy — surgical removal of lymph nodes in the pelvis, examined for cancer cells
• Seminal vesicle biopsy — removal of fluid using a needle, examined for cancer cells

NCI also describes the PSMA PET scan as an imaging procedure used to help find prostate cancer cells that have spread outside the prostate, into bone, lymph nodes or other organs.

Asking which of these apply to you, and when results are expected, is a reasonable way to get your footing.

This distinction matters most at the high end of the scale, because it is where the two get conflated.

Grade describes how abnormal the cells look and how quickly the cancer is likely to grow and spread. Stage describes where the cancer is. NCI treats them as separate processes and then combines them: the Grade Group and PSA level are used to stage prostate cancer.

A high grade raises the question of whether the cancer has spread. It does not answer it. The staging tests do that.

• Stage — PSA level, Gleason score, Grade Group, how much of the prostate is affected, whether the cancer has spread
• The patient's age
• Whether the cancer is newly diagnosed or has recurred
• For options specifically: other health problems, expected side effects, past treatment, and the wishes of the patient

NCI lists a wide range of treatment types for prostate cancer, including surgery, external and internal radiation therapy, radiopharmaceutical therapy, hormone therapy, chemotherapy, targeted therapy, immunotherapy and bisphosphonate therapy. Which are relevant depends on the full picture, not on the grade alone.

It will not tell you what your score means for your future. You may have come here after typing a number into a search box at a bad moment. The honest answer is that this page cannot see your stage, your PSA, your scans or your health. Those are the things NCI says the answer depends on.

What it can do is make sure you walk into the next appointment knowing what the number describes and what to ask.

• What are the two pattern numbers, and does my report state Grade Group 5?
• What was my PSA level at diagnosis?
• Which staging tests are being done, and when will we have results?
• Has a second pathologist reviewed the slides?
• Will my case be discussed at a tumor board or multidisciplinary meeting?
• What are the realistic options, and what does each involve day to day?
• Who do I contact between appointments if something changes?

See What Does a Gleason Score Mean?, What Does a Gleason Score of 8 Mean?, and Getting a Second Opinion.

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