See pictures of the diffferent grades below.
Listing of pictures:
Benign (Normal) Tissue
High Grade PIN
Gleason Pattern 2
Gleason Pattern 3
Gleason Pattern 4
Gleason Pattern 5
Perineural Invasion
Remember the higher the Gleason Grades (4 and 5) the less PSA is produced. It is possible to be diagnosed with a Gleason score of 8, 9 or 10 and have a PSA of less than 1. More commonly we will see PSA's in the 1 to 2 level with this diagnosis. These types of cells produce very little PSA, very difficult to stop and has a very poor prognosis. One really needs an expert Pathologist to read these. Click "here" for a list of expert pathologists.
Also shown is perineural invasion a feature not uncommonly seen in needle biopsies and radical prostatectomy specimens. Perineural invasion may be seen with any prostate cancer. For additional information on perineural invasion click "here" and "here". You can also go to PubMed and enter ["perineural invasion" AND prostate] without the brackets where it says Search PubMed for_______________ enter the search term after the "for".
We do see the local pathologist who may grade the cells on a lower level than they actually are. Again another reason to get you slides to an expert.
For further detail about Gleason Grading and prognostic factors click "here" .
Benign (Normal) Tissue
Benign Glands: Intermediate to large size glands with irregular branching lumens. There is no enlargement of nuclei or nucleoli. One of the benign glands (on the right) contains a pink globular structure called "corpora amylacea."
High Grade PIN
High-grade Prostatic Intraepithelial Neoplasia (HGPIN): High-grade PIN is considered to be the most likely precursor of prostate cancer. It has the architectural features of benign glands but the cytologic features (i.e. cellular features) of cancer. It is a proliferative lesion (i.e. dividing more rapidly than benign glands) and shows enlargement of nuclei and nucleoli. Patients with high-grade PIN only in needle biopsy are at increased risk of developing cancer and must undergo repeat biopsy within the next 3-6 months. Studies have shown that 40% to 60% of repeat biopsies will have cancer (Davidson et al. Prostatic intraepithelial neoplasia is predictive of adenocarcinoma. Journal of Urology, 154:1295-99, 1995)
Gleason Pattern 2
Gleason grade 2: The cancer focus is not circumscribed (unlike in Gleason grade 1). The malignant glands show slight variation in size and shape; however, the glandular contours are round and somewhat uniform. The nuclei are enlarged and contain prominent nucleoli (blue dots inside nuclei).
Gleason Pattern 3
Gleason grade 3: This is the most commonly seen pattern. There is considerable variation in size, shape, and spacing of the glands. The glands are haphazardly infiltrating the stroma; however, they are still discrete (i.e. there is no fusion of glands - a hallmark of Gleason grade 4). Some of the glands have occluded or abortive lumens.
Gleason Pattern 4
Gleason grade 4: The most distinguishing feature of this grade is fusion of glands. The fused glands form an anastomosing network or cord-like arrangements with punched-out glandular lumens.
Gleason Pattern 5
Gleason grade 5: The tumor in Gleason grade 5 grows in solid sheets (as seen here) without forming any discernible glands. Areas of necrosis may be present. The punched-out circular lumens seen in this case correspond to "signet ring-cell pattern" - a variant of Gleason grade 5. Other rare patterns such as small cell carcinoma are also included in Gleason grade 5 and tend to behave aggressively. Note a single large benign gland in the upper left corner.
Perineural Invasion: The cancer glands are intimately associated with and surround the two nerve twigs. Cancer may escape the prostate along these nerves and spread into adjacent organs. This is not a cell variant and is only shown here because it is unusual to be seen in a biopsy. The PSA would not be reduced with this unless it is associated with the following variants.
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Information You Should Read
Stanford Univ. video on PCa
The Prostate - What, Where
The Prostate Biopsy
How To Tell a "Physician Artist"
The Doctors Appointment
Insignificant Cancer
Vocabulary, Glossary, etc.
Tables, Tests, Markers etc.
Gleason Info and Partin Tables
PSA - What it is and means
Locally Advanced Cancer
BPH
Prostatitis
Other Diagnostic Tools
Veterans Information
