“What is the Gleason score in my pathology report?”

Gleason 3+4=7 means that there are predominantly well-formed glands with lesser component of poorly of poorly formed / fused / cribriform glands. Gleason 4+3 means that there are predominantly poorly formed / fused / cribriform glands with lesser component of well-formed glands. Thank you.

Gleason score 7 with 3+4 means prostate cancer with more Gleason pattern 3 component than 4 component, indicating a better outcome compared to Gleason score 7 with 4+3 (pattern 4 is more than 3 component). Gleason score of 3+4 =7 is assigned as prognostic grade group, better prognosis but Gleason score of 4+3 =7 assigned as prognostic grade group 3, worse prognosis.

The short answer is that 4+3, where pattern 4 is more common than 3, is at a somewhat higher risk for recurrence than 3+4. Even though the Gleason score is still “7,” the grade group changes to group 4 from 3.

The Gleason score is a way to judge the severity of a patient's prostate cancer. There are 5 patterns. The first number in the equation is the most prevalent pattern, and the second number is the next prevalent pattern. 1 is the best, and 5 is the worst. Therefore, a 4+3 cancer is a more severe cancer than a 3+4.

RB Thomas, MD

Gleason scores are calculated based on the pattern of tumor growth when looked at under the microscope, along with which particular pattern is the most prevalent. The first number is the most prevalent pattern and the second number is the most common. The patterns are graded from 1-5, and since you have 2 patterns scored, you add them together to get a total score. Thus, while a score of 7 sounds the same, a 3+4=7 versus a 4+3=7 is not equivalent. A 4+3=7 is a worse score, since this means that the most prevalent pattern is a higher pattern.

The Gleason score is the sum of the primary and secondary patterns of cancer referred to as Gleason grades. So, Gleason grade 3 + Gleason graded 4 for a total Gleason score 7. The Gleason score is recommended in all prostate specimens with adenocarcinoma. It is used to guide individual treatment decisions. A Gleason 3+4 is different than 4+3 as it correlates with recurrence risk and prognosis.

Yes a Gleason score 3 + 4 is different from a Gleason score 4 + 3 although they both add 7. The fact is that the highest the number the more aggressive the tumor will be and the highest is the percentage of patients that would have recurrence of an increase in the prostate specific antigen PSA in 5 years. Basically the Gleason score is a grading system based on the histology of the two most predominant patterns in the biopsy. The more the tumor resembles normal tissue the lower the number. Gleason patterns run from 1 to 5 and the two main patterns in the biopsy are added up. I find this article very informative an easy to understand. Your Gleason 3 4 has better
prognosis and outcomes than a Gleason 4 3.
https://pcri.org/insights-blog/2016/3/10/interpreting-a-pathology-report-15-biopsy-and-gleason-questions-answered-by-a-leading-pathologist

Yes, it is different. The prognosis is better with GLEASON 3+4.