What is the difference between a Gleason 4 + 3 and Gleason 4 + 4 (or Gleason 8)

[Terry33]

The majority of my biopsy core samples tested positive at Gleason 4 + 3, however, my urologist referred to them as Gleason Eights, not sevens or seven and a halfs excetera. Can you shed any light please? Thanks.

[tango65]

The GS 4+3 indicates that in a scale 1-5 for abnormality (atypia) the most common abnormal pattern is 4 and the second most common abnormal pattern is 3.

In a Gleason score of 4+4 most of all the cancer has an abnormal pattern of 4.

Since what makes a cancer more aggresive is the degree of atypia of the cells , a Gleason 4+3 have the most common abnormal pattern equal to the one in a Gleason of 4+4. That is the reason that Gleason 4+3 is called the bad 7 to differentiate from Gleason 3+4 where the most common abnormal pattern of cells is Gleason 3.

"Since prostate tumors are often made up of cancerous cells that have different grades, two grades are assigned for each patient. A primary grade is given to describe the cells that make up the largest area of the tumor and a secondary grade is given to describe the cells of the next largest area. For instance, if the Gleason Score is written as 3+4=7, it means most of the tumor is grade 3 and the next largest section of the tumor is grade 4, together they make up the total Gleason Score. If the cancer is almost entirely made up of cells with the same score, the grade for that area is counted twice to calculated the total Gleason Score."

prostateconditions.org/abou...

The Gleason score has been simplified in Grade Groups:

Grade Group 1 = Gleason 6

Grade Group 2 = Gleason 3 + 4 = 7

Grade Group 3 = Gleason 4 + 3 = 7

Gleason Group 4 = Gleason 8

Gleason Group 5 = Gleason 9 or 10

I think your doctor refers to Gleason 8 because the predominant abnormal pattern in a Gleason score 4+3 is 4 the same than in a Gleason Score of 8.

[Terry33 in reply to tango65]

Wow, a very thorough and enlightening response. Much appreciated that you took the time. That clears up a lot. Thank you so much! All the best on your journey.

[Hidden in reply to tango65]

Great explanation . Thanks

[tennis4life in reply to tango65]

Wow all these years and no one ever explained the Gleason Scores in this much detail. Good stuff Tango!

[Tall_Allen]

what PSA and stage? it's always a good idea to get Epstein's confirmation, if you're in the US.

[davebliz in reply to Tall_Allen]

What is Epstein’s confirmation mean? Thanks.

[Tall_Allen in reply to davebliz]

pathology.jhu.edu/departmen...

It costs $250 and is definitive.