Stage and Grade

The current Gleason grading system recognises three patterns or grades of cancer. These are given a number 3 to 5. However, the pattern of any one cancer can be mixed and the prognosis for any patient depends upon this mixed pattern. The two most common patterns are each given a separate number and then the two numbers are added to give the Gleason grade, for example 3+4=7. The Gleason grade can therefore be between 6 and 10.

A Gleason grade or score 3+3=6 tumour has a relatively good prognosis and is often just monitored, a Gleason 7 tumour is intermediate and a Gleason 8 to 10 has a poor prognosis. In the Gleason 7 category a Gleason 4+3=7 tumour is a worse tumour than a Gleason 3+4=7 as there is more Gleason 4 pattern than 3 pattern.

As well as the pattern of the growth or tumour, the extent of the cancer felt on digital rectal examination (DRE) is also important in estimating a prognosis. The extent of cancer is referred to as the stage. Stage 1 (T1) cancers cannot be felt on DRE, stage 2 (T2) cancers can be felt, but still feel to be within the prostate, stage 3 (T3) are felt to have extended outside the prostate and stage 4 (T4) are felt to be well outside the prostate, invading adjacent organs such as the bladder or pelvic wall.

Click here for the video, 'Prostate cancer and staging'.


About Phillip

Phillip is the Chairman of the Department of Urology, St Vincent's Private Hospital and Clinic since 2003, and a Director of the St Vincent's Prostate Cancer Centre.

The Australian Prostate Cancer Research Centre in New South Wales recently appointed him as clinical director. He is also a member of the National Prostate Cancer Research Centre

Philip is currently the highest volume robotic surgeon in Australasia

He is perhaps best known for his work developing nerve sparing techniques to help patients maximise potency