Gleason score: What the former president’s diagnosis reveals

News of former President Joe Biden’s prostate cancer came with a Gleason score of 9, a number most people may be unfamiliar with.

A Gleason score ranges from 6 to 10 and helps inform health care providers about the aggressiveness of your prostate cancer.

“In general, a Gleason score of 6 is considered low risk, 7 is intermediate risk, and 8, 9, and 10 are high risk,” explains Dr. James H. Griffin, a urologist at Advocate Health Care.

It’s different than the cancer stages you may be used to hearing about.

“A Gleason score is used because the tumor staging system doesn’t completely characterize prostate cancer by itself,” Dr. Griffin says. “Instead, the staging tells us whether the tumor could be felt, if it has spread beyond the prostate or if the cancer has spread to peripheral tissues or organs.”

How is a Gleason score calculated?

“A Gleason score is derived from adding two Gleason grades, one from the most predominant and another from the second most predominant cancer cell,” Dr. Griffin says. “Using a microscope, pathologists assign the prostate cancer cells a grade between 3 and 5, with 3 being least aggressive and 5 being most aggressive.”

He says separating individual grades helps accurately define cancer risk. For example, you can swap the first and second most predominant grades and still have the same Gleason score. However, if the first grade from the predominant cancer cell is lower, then your risk for cancer is lower than if it were the other way around.

How do Gleason scores inform treatment?

The Gleason score is just one of many factors that determine your prostate cancer treatment.

“Your health care provider will use your Gleason score, prebiopsy prostate-specific antigen (PSA) level, total number of cores (tissue samples) that are positive for prostate cancer, prostate volume, and imaging for metastatic disease, specifically if you are at intermediate or high risk, to guide your treatment,” Dr. Griffin says.

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