Gleason grading and scores

• grading based on a scheme by Gleason
• five patterns depend on the pattern and degree of glandular formation
• Gleason score based on primary and secondary areas
• Minimum score 2
• Maximum score 10
• This patient's score is 45=9

• only considers degree of glandular formation in predominant areas
• without taking into account of the cellular differentiation

• PSA levels
• clinical and pathological staging
• lymph node and bone metastasis
• scores 2 to 4 - almost never aggressive
• scores 8 to 10 - most die of disease

• invasion of the 'capsule'
• tumour bulk
• Partin tables (combination of  Gleason score and tumour bulk)

• most common to bone and lymph nodes
• bone metastases are often sclerotic
• common bones involved: lumbar spine, sacrum and pelvis