Understanding Prostate Cancer: Gleason Score, PSA, and Aggressiveness

Understanding Prostate Cancer: Gleason Score, PSA, and Aggressiveness

Published on: May 2, 2025

In the realm of prostate cancer, two key terms often surface: the Gleason score and PSA. Understanding these can help patients and their families navigate this complex disease.

What is the Gleason Score?

The Gleason score, ranging from 6 – 10, evaluates the aggressiveness of prostate cancer by examining how the tumor cells are arranged under a microscope.

• A score of 6 or below indicates low – grade, non-aggressive cancer.
• A score of 7 is considered intermediate.
• Scores between 8 – 10 are high – grade and suggest aggressive cancer.

What is PSA?

PSA, or Prostate – Specific Antigen, is a protein in the blood used for early detection and monitoring of prostate cancer.

• A PSA level below 4 ng/mL is generally normal, but it’s not a guarantee.
• Levels between 4 – 10 ng/mL put a man at an intermediate risk.
• A PSA above 10 ng/mL signals a higher risk of aggressive or metastatic disease.

What Makes Prostate Cancer Aggressive?

Several factors contribute to the aggressiveness of prostate cancer.

• A high Gleason score, especially 8 or above, means the cancer cells are poorly differentiated and more likely to spread.
• Elevated PSA levels also correlate with advanced disease, though age and prostate size need to be considered.
• Older men (over 80), those with a PSA of 10 ng/mL or higher, and an abnormal digital rectal exam often have more aggressive cancers.
• The percentage of high-grade patterns in the tumor and the presence of metastasis also play a role.

Non – Non-Aggressive Prostate Cancer

On the other hand, low Gleason scores (6 or less), stable or low PSA levels, and localized tumors may allow for active surveillance. Instead of immediate treatment, doctors monitor the cancer closely.

Conclusion

Combining the Gleason score, PSA levels, imaging results, and other clinical factors helps doctors stratify the risk and make informed treatment decisions. Knowledge of these concepts empowers patients to be more involved in their healthcare journey.