The Gleason Score & ISUP Grading (how aggressive the cancer is)

Gleason Score

This is given after a pathologist has examined under a microscope cancerous tissue obtained from the needle biopsy. The cells identified are given a grade number from 1 to 5, depending on the abnormality of the cells, 1 being the lowest, 5 the highest. The grades of the two most common patterns are added together to give a score from 2 to 10. The higher the score, the more aggressive and fast-growing the cancer. Scores totalling 5 or less are insignificant and are not reported.

  • A Gleason score of 6 (cells are well differentiated) is ‘favourable’
  • A Gleason score of 7 (cells are moderately differentiated) is ‘average’
  • A Gleason Score of 8–10 (cells are poorly differentiated) is ‘adverse’

Gleason Patterns

The consultant will give you a total score out of 10, which should be split down as two numbers out of 5: for example, 4+3. The first number is the predominant grade, so a score of 4+3=7, for example, is likely to prove slightly more aggressive than a score of 3+4=7.



Gleason patterns
(Grade 5 is the most aggressive)

ISUP Grading

In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system called the ISUP Grade Groups. The ISUP Grade Group system is simpler, with just five grades, 1 to 5.

Your consultant may report your score either as a Gleason Score or an ISUP Grade Group, or you may receive both scores.

ISUP Grading

Risk Group

ISUP Grade Group

Gleason Score


Grade Group 1

Gleason <6

  Intermediate Favourable

Grade Group 2

Gleason 7 (3+4)

  Intermediate Unfavourable

Grade Group 3

Gleason 7 (4+3)


Grade Group 4

Gleason 8. 


Grade Group 5

Gleason 9–10