Wade Boggs revealed his Gleason Score for prostate cancer. What does the score mean?
Wade Boggs spent his long and illustrious Major League Baseball career counting hits and runs. But recently the former third baseman for the Boston Red Sox revealed he is now more concerned with another type of score: his Gleason Score for prostate cancer.
Following an MRI and a biopsy, it was determined he had a Gleason Score of 7 and he is being treated for the disease with local radiation.
But what is a Gleason Score when it comes to prostate cancer?
“The Gleason Score is the score the pathologist uses when looking at a specimen taken from the prostate, either from a biopsy or following surgery, to clarify and characterize how the cells/glands look under a microscope,” said Timothy O’Rourke, a urologist with Urology Associates of Cape Cod. “When cancer is present, the architecture of the prostate is abnormal and tumors (adenocarcinomas) form. The aggressiveness of the cancer correlates with how abnormal the cancer cells look.”
When pathologists look at the specimen, they assign a number to the prostate cancer cells from 1-5 and it is based on how abnormal the cells look, according to the National Library of Medicine. Grade 1 cells look like normal prostate cells and grade 5 cells appear much different than normal cells.
The Gleason score is determined by adding the two most common grade cells found in the largest areas of the tissue sample. For example, if the tissue sample has grade 3 cells (typically the lowest score assigned to tumor grade because lower scores are near normal cells) followed by grade 4, the Gleason score is 7. The most predominant cell pattern’s score is put first in the equation.
In addition to the grades of the tumor cancer cells to get a Gleason score, the resulting score was further divided into five grade groups to make it easier to understand.
Dr. O’Rourke explains the Gleason score and the 5-grade group system to his patients with the following:
- Grade group 1: Gleason score of 6 (3+3) (low-grade cancer).
- Grade group 2: Gleason score of 7 (3+4) (intermediate-grade cancer).
- Grade group 3: Gleason score of 7 (4+3) (intermediate-grade cancer).
- Grade group 4: Gleason score of 8 (4+4) (high-grade cancer).
- Grade group 5: Gleason score of 9-10, (4+5), 5+4), (5+5) (high-grade cancer).
“This is one of the number of variables we take into consideration when deciding treatment,” Dr. O’Rourke said. The other considerations are:
- PSA (prostate-specific antigen) value. Higher PSA levels can sometimes correlate with a more aggressive or advanced cancer.
- Imaging, in the form of MRI or PSMA PET/CT Scan for staging considerations.
- Prostate examination/digital rectal examination (“DRE”).
Treatment Options
“Treatment options vary significantly depending on your personal risk stratification and may include several modalities,” said Dr. O’Rourke. “These range from active surveillance (monitoring closely with PSA, MRI, and confirmatory prostate biopsy typically around one year after diagnosis) to radical prostatectomy (surgical removal of the prostate and seminal vesicles with or without lymph node dissection/sampling performed by a minimally invasive robot-assisted approach), to several forms of radiation, and, at more advanced stages, may include medication to block testosterone, which feeds prostate cancer.”
Men with unfavorable intermediate-risk to high-risk, will have staging imaging performed, he said. This is done with a PSMA PET CT Scan, which is very sensitive for detecting prostate cancer in other areas of the body.
“That is the most important determining factor of what modality of treatment is up front, because if the cancer has spread to other parts of the body, the treatment approach will be different because it’s not a curative situation.,” he said.
There are a variety of clinical variables and there are many considerations taken into account when deciding how to approach managing prostate cancer or how to approach options for men who have elevated PSAs, Dr. O’Rourke said. “It’s not a one track for everyone.”
