Senior Director & Unit Head, Urology, Kidney Transplant, Uro-Oncology, Robotic Surgery, Max Hospital, Gurugram
Part 6 of 11 in Prostate Cancer: Diagnosis and Management
The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
September 6, 2026
The biopsy reading gives Dr. Amit Goel a Gleason score, which grades how aggressive the cancer looks under the microscope by how differentiated the glandular tissue still appears. Grade 1 and grade 2 patterns are not considered cancerous at all; grade 3 to grade 5 range from minimally to very highly aggressive prostate cancer, with well-defined gland arrangement in the lower grades giving way to poorly differentiated tissue by grade 5.
How the Score Is Calculated
The Gleason score combines the most common pattern seen on biopsy with the second most common pattern, added together to produce a total out of 10. Which pattern is primary matters for the resulting risk category, not just the sum: Gleason group 1 is a score of 6 or lower; group 2 is 3+4 (a total of 7, with pattern 3 primary); group 3 is 4+3 (also a total of 7, but with pattern 4 primary, a worse prognosis than group 2 despite the identical sum); group 4 is 4+4; and group 5 covers 5+4 or 5+5.
Why the Score Drives Treatment Decisions
Dr. Goel was direct with his audience about why this matters: treatment for prostate cancer is decided by weighing the stage, the patient's age and life expectancy, and the Gleason score together, not any one of them alone. A patient's Gleason score, alongside their PSA and clinical stage, feeds directly into risk categorisation tools such as the CAPRA score, which determine whether active surveillance, radiotherapy or surgery is the right next step.
This article is based on a Jivo Masterclass session conducted by Dr. Amit Goel, Director and Head of Unit, Renal Transplant, Uro-oncology, Urology and Robotic Surgery, Max Hospital, Gurugram, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Amit Goel taught doctors across Africa on April 20, 2025.
FROM THE LIVE Q&A
Dr. Yanik
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?
Dr. Amit Goel
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
Frequently Asked Questions
What is the average cost of robotic surgery for prostate cancer?▼
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
What is the management of metastatic prostate cancer?▼
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?▼
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
What does a Gleason score of 6 mean?▼
A Gleason score of 6 or below falls into Gleason group 1, the lowest-risk category on biopsy.
Why does it matter which Gleason pattern is primary?▼
A score of 3+4 (group 2) and 4+3 (group 3) both add up to 7, but 4+3 carries a worse prognosis because the more aggressive pattern (4) is the dominant one, not the secondary one.
In This Series: Prostate Cancer: Diagnosis and Management
- 1.Diagnosis and Management of Prostate Cancer
- 2.Prostate Cancer Risk Factors and Why Men of African Descent Face the Highest Risk
- 3.Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
- 4.How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
- 5.Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
- 6.The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
- 7.Staging Prostate Cancer: TNM Classification and PSMA PET Scans
- 8.Choosing a Treatment: Risk-Based Options From Active Surveillance to Surgery
- 9.Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
- 10.The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
- 11.Managing Metastatic and Castration-Resistant Prostate Cancer