V.3.7.7 Prostate – Gleason Score

(Site: prostate excluding lymphomas)

Use these instructions for cases diagnosed on or after 01/01/2014 only.

For cases diagnosed on or before 12/31/2013, see Section V.3.5.6

Coding Instructions:

• Use the highest Gleason score from the biopsy/TURP or prostatectomy/autopsy.  

• Use a known value over an unknown value.

• Exclude results from tests performed after neoadjuvant therapy began.

Usually prostate cancers are graded using Gleason score or pattern. Gleason grading for prostate primaries is based on a 5-component system (5 histologic patterns). Prostatic cancer generally shows two main histologic patterns.  The primary pattern, the pattern occupying greater than 50% of the cancer, is usually indicated by the first number of the Gleason grade, and the secondary pattern is usually indicated by the second number. These two numbers are added together to create a pattern score, ranging from 2 to 10.

• If there are two numbers, assume that they refer to two patterns (the first number being the primary pattern and the second number the secondary pattern), and sum them to obtain the score.  

• If only one number is given on a particular test and it is less than or equal to 5 and not specified as a score, do not use the information because it could refer to either a score or a grade.

• If only one number is given and it is greater than 5, assume that it is a score and use it.

• If the pathology report specifies a specific number out of a total of 10, the first number given is the score.

Example: The pathology report says Gleason 3/10. The Gleason score would be 3.

• If the grade cannot be coded using the Gleason Score/Grade table below, then use Grade rules for solid tumors, see Section V.3.7.2

Gleason Score/Grade

Note: This grading system is coded in a site-specific factor for the applicable CS schema.

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