Classification of prostate cancer according to the Gleason grading system

To characterize prostate cancer, oncologists use 2 main criteria - the Gleason grading system and the TNM classification.

Classification of prostate cancer according to the Gleason grade

Adenocarcinoma is a malignant tumor forming from glandular cells. These cells are part of most of the internal organs of a person.

An American pathologist Donald Gleason made a histological basis for determining the degree of cells morphology.

In the most (more than 95%) cases, the tumor appears to be adenocarcinoma with different aggressiveness grades.

For its evaluation, 2 samples of different tumor locations are used, estimating them with 1-5 points. Where:

point: identical rounded glandular cells, a tumor has definite boundaries.
points: the edges of a tumor are indefinite, the cells are slightly different from each other.
points: different glandular cells, the edge of a tumor is poorly defined.
points: small cells appear among glandular ones, there are infiltrates (induration caused by the accumulation of cellular tumor elements) from a tumor.
points: normal cells disappear, a tumor has no edge.

Then the results are summed up.

The received results are interpreted as follows:

2-5 points. Low invasiveness. Patients with such tumors can be simply observed have chemotherapy and radiation treatment methods.

6-7 points. Moderate invasiveness. The planned operation is appointed, the forecast in most cases is favorable.

8-10 points. High risk of metastasis. With such histological data, metastases are sought even if there are no symptoms and moderate size of a tumor.

The Gleason grading system primarily describes the potential danger of a tumor - the speed of growth, the tendency to metastasize.

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Prostate cancer in the international TNM Classification

The TNM Classification is a grading system of malignant new formations at their localizations

The Classification consists of 3 indicators: T (tumor), N (lymph nodes), M (metastasis).

T (tumor) indicated the cancer stage:

T0	the foci of the cells is up to 1cm in diameter. It can be detected with PET-CT or MRI
T1	the foci of the cells is up to 2cm in diameter. No symptoms. Can be identified with lab tests.
T2	the foci in two lobes of the prostate glands. There are some problems with urination.
T3	a tumor replaces the prostate gland, and sprouts outside the сapsule. In case of T3b - a tumor affects seminal vesicles.
T4	a tumor sprouts outside the capsule and affects neighboring organs.

Prostate cancer T3 does not mean a tumor of stage 3. The size of the body of a tumor is only one of the parameters. For instance, a tumor T2N0M1 is considered as a 4-A stage (with T size moderate), and T3N0M0 is 2-B.

N is the number of metastasis in the lymph nodes. For prostate cancer, this indicator can be from 0 to 4, where 4 means multiple metastases, and 0 - no apparent metastasis.

Nx	regional lymph nodes cannot be detected.
N0	no metastasis in regional lymph nodes.
N1	a tumor spreads to closest regional lymph nodes.
N2	a tumor spreads in the regional lymph nodes at a distance >2 to >5cm.
N3	a tumor spreads to distant (or numerous) lymph nodes.

Also, cancer hospitals calculate the metastatic risk factor.

Indicator M (metastasis) shows the presence of metastasis in distant organs.

M0	regional lymph nodes cannot be detected.
M1	distant organs have no metastasis.