PSA and Gleason Score

Top 10 Comparison Between PSA and Gleason Score

A Brief Overview of PSA and Gleason Score

PSA and Gleason Scores are crucial to diagnosing and managing prostate cancer.

The most significant differentiator that differentiates PSA or Gleason scores is the fact that PSA is a blood test that can diagnose prostate cancer by measuring the level of prostate-specific antigen (PSA) in the blood. Gleason score can be described as a rating method to identify prostate cancer in which prostate cells glands are rated by a number from 1-5.

Prostate cancer is a form of cancer that affects the prostate gland, which is a tiny walnut-shaped gland that occurs in males. The screening of prostate cancer may be carried out using various techniques. PSA, as well as Gleason Score, are 2 different methods for screening and diagnosing prostate cancer.

What is PSA?

PSA or Prostate-Specific Antigen is a protein produced primarily by cells within the prostate gland – part of the male reproductive system – as part of its main purpose to liquefy seminal fluid during ejaculation for more rapid motility of sperm and help facilitate its transport out through ejaculation. It’s produced predominantly by cells within this organ. It plays an essential part in male fertility.

Figure 01: PSA

PSA plays an essential role as a biomarker of prostate-related conditions, most prominently cancer. While its use does not exclusively relate to cancer diagnosis, elevated PSA levels could indicate inflammation, infection, enlargement (benign prostatic hyperplasia), or cancerous cells present within the prostate gland.

As an effective screening method for prostate cancer, PSA tests measure the concentration of PSA in an individual’s blood. While elevated PSA levels don’t definitively diagnose cancer; rather, they raise suspicion and prompt further evaluation.

PSA levels can fluctuate according to age, race, prostate size and other factors and false positives and negatives may arise during testing; thus leading to ongoing debates over its accuracy and reliability.

PSA tests remain an effective initial method for prostate cancer detection, their limitations have led to additional factors being integrated, like biopsies with Gleason Score analysis to more fully characterize the aggressiveness of cancer aggressiveness and inform treatment decisions. PSA serves as an early warning indicator that may alert one of the potential prostate issues; further examination can confirm or rule out conditions like cancer.

What is the Gleason Score?

The Gleason Score is an objective grading system developed to assess the aggressiveness of prostate cancer based on microscopical examination of tumor tissue obtained through biopsy. Named for pathologist Donald Gleason, this scoring system gives important insight into both potential behavior and prognosis of this form of malignancy.

As part of a prostate biopsy procedure, tissue samples are examined under a microscope by a pathologist using the Gleason Score classification system to grade cancer cells based on their appearance and organization; two patterns (called grades or patterns ) representing the most prevalent tumor growth patterns within the sample are assigned grades from one to five with five being highly abnormal cells resembling normal cells and one normal-appearing.

 Gleason Score
Figure 01: Gleason Score

Gleason Score combines two pattern scores into an aggregate score ranging from two to ten; lower scores (2 to 6) indicate less aggressive cancers while higher ones (7-10) can indicate faster-growing tumors that require further investigation by healthcare practitioners. Gleason Score provides physicians with guidance in choosing appropriate treatments as it indicates the likelihood that prostate cancer might spread beyond its primary location.

Modern clinical practice often reports the Gleason Score as the sum of two predominant pattern scores; for instance, 3 + 4 = 7 indicates that grade 3 predominated and grade 4 secondary patterning were predominant and secondary patterns respectively. This system facilitates decision-making when treating cancer; physicians can tailor interventions depending on a cancer’s potential aggressiveness as well as patient health status.

Histological Variants of PSA and Gleason Score

Nourishing and rejuvenation programs to address urinary health are becoming more prominent as we enter 2017. Unfortunately, they still face many hurdles; for example, navigating their myriad health benefits is no small undertaking! While PSA (Prostate-Specific Antigen) biomarker levels provide a general indication of prostate health when measured against tissue samples; its histological variants or patterns don’t change dramatically over time like tissue does – making PSA levels an invaluable indicator.

Gleason Score is a histopathological grading system used to grade prostate cancer tissue biopsies obtained through biopsy, with one to five scores assigned per histological pattern visible under a microscope based on how cancer cells are organized and their similarity or dissimilarity to normal prostate tissue. The two most prevalent patterns receive scores between 1-5; when combined, their total score gives us our Gleason Score between 2-10.

As far as my knowledge goes, the PSA doesn’t contain histological variants as it’s just a blood marker; while Gleason scoring involves looking under a microscope at cancer tissue. If that wasn’t what you meant by “histological variants”.

Key Differences Between PSA and Gleason Score

Here’s a comparison chart highlighting the key differences between PSA and the Gleason Score:

Aspect PSA Gleason Score
Measurement Blood biomarker Histopathological grading of tissue
Information Provided General prostate health indicator Cancer aggressiveness and growth patterns
Diagnostic Stage Early detection and screening tool After biopsy and tissue analysis
Factors Influencing Accuracy Affected by non-cancer conditions Dependent on pathologist expertise
Application in Treatment Aids in further diagnostic steps Guides treatment strategy
Interpretation Elevated levels warrant attention Higher scores indicate more aggressiveness
Limitations False positives and negatives Limited to biopsy samples
Purpose Screening and initial suspicion Refinement of diagnosis and treatment
Collaboration Used alongside other tests Part of a comprehensive diagnostic picture
Monitoring Monitors change over time Monitors cancer progression during treatment

Why PSA and Gleason Score are important for Prostate Cancer Diagnosis

PSA (Prostate-Specific Antigen) and Gleason Score are integral parts of prostate cancer diagnosis, providing vital data that assists doctors and improves patient outcomes.

  • Early Detection and Screening with PSA: (L-) Both testing options enable early diagnosis of prostate cancer by measuring levels of PSA blood serum; when elevated PSA levels appear they could signal potential prostate issues and cancer development. Screening allows timely intervention through the identification of individuals at higher-than-usual risk through PSA screening tests.
  • Risk Stratification: PSA levels can help identify low, intermediate, or high-risk groups in order to aid treatment planning and assist in patient stratification.
    Monitoring: These tests serve to track cancer progress as well as treatment effectiveness over time.
    Decision-Making: PSA results can help guide further diagnostic steps like biopsies.
  • Gleason Score: Aggressiveness Assessment: This score gives insight into the aggressiveness and likely behavior of prostate cancer cells.
  • Treatment Guidance: It assists physicians in making treatment decisions by helping to determine an individualized course of intervention – surgery, radiation or active surveillance- and its appropriate level.
  • Prognosis Estimation: It allows an estimate on likelihood and outcomes related to cancer progression or prognosis estimation.
  • Personalizing Treatment: Gleason Score helps in tailoring treatments according to cancer’s aggressiveness and patient health status, and monitoring progress during both cancer treatments and surveillance.

What is the first line of treatment for PSA?

Prostate-specific antigen (PSA) should not typically be treated directly as it serves as a biomarker to evaluate prostate health and identify any issues like cancer. Elevated PSA levels may indicate various prostate conditions; treatment will depend upon further diagnostic steps taken by healthcare practitioners.

If elevated PSA levels are due to noncancerous conditions like benign prostatic hyperplasia (BPH) or prostatitis (inflammation of the prostate), treatment options could include medications, lifestyle modifications or other interventions tailored to effectively manage those specific conditions.

Depending on the stage and aggressiveness of prostate cancer, initial treatments for it can vary.

Treatment options for prostate cancer could include:

  • Active Surveillance: For low-risk or slow-growing cancers, active surveillance involves closely tracking their progress without immediate treatment.
  • Surgery:  Radical prostatectomy involves surgically extracting both the prostate gland and surrounding tissue from its original location. It’s often employed to treat localized prostate cancer.
  • Radiation Therapy: Radiation therapies such as external beam radiation or brachytherapy (injecting radioactive seeds into the prostate gland) can be used to target and destroy cancerous cells in order to successfully combat prostate cancer.
  • Hormone Therapy: When cancer has spread or become high-risk, hormone therapy may be used to lower levels of testosterone that fuel its spread and progression.
  • Chemotherapy: Chemotherapy may be used for more advanced or aggressive prostate cancers that have spread beyond the prostate gland.
  • Immunotherapy and Targeted Therapies: Newer approaches use immunotherapy or targeted therapies to harness your body’s own immune system or to address specific molecules involved in cancer growth.

What is the first line of treatment for Gleason Score?

Gleason Score itself cannot be treated directly as it serves only to assess the aggressiveness of prostate cancer based on the histological appearance of tumor tissue obtained through biopsy. Treatment choices depend upon various factors including Gleason Score, stage, patient health status and preferences.

The Gleason Score plays an essential part in making treatment decisions for prostate cancer patients. It helps assess its aggressiveness and determine if it has spread beyond local boundaries.

Common first-line treatments for this condition can include:

  • Active Surveillance: For low-risk prostate cancer cases with lower Gleason Scores, active surveillance may be recommended as a strategy for monitoring progression over time with regular check-ups and tests.
  • Surgery: Radical prostatectomy involves extracting all or parts of the prostate gland and surrounding tissues for treating localized prostate cancer with favorable Gleason Scores. It’s a commonly employed solution.
  • Radiation Therapy: Radiation therapy may take the form of external beam radiation or brachytherapy (implanting radioactive seeds to target and kill cancer cells), making this an option for localized or locally advanced prostate cancer cases with differing Gleason Scores.
  • Hormone Therapy: When cancerous tumors with higher Gleason Scores have spread beyond the prostate, hormone therapy may help lower testosterone levels to stave off further expansion of cancerous growth. This may reduce its rate of expansion.
  • Combination Therapies: Some conditions require multiple forms of therapy, such as surgery followed by radiation or hormone treatment.
  • Chemotherapy and Targeted Therapies: These forms of treatment should only be utilized for more advanced cases that do not respond well to initial therapies.

Pros and Cons of PSA and Gleason Score as Prostate Cancer Biomarkers

PSA (Prostate-Specific Antigen):


  • Early Detection: Whilst PSA tests can detect potential prostate issues such as cancer early, allowing timely interventions, they’re widely available and relatively straightforward to take.
  • Screening: PSA tests serve as an effective screening tool to identify individuals who might require further diagnostic evaluation, while their levels can also be tracked over time to monitor changes in prostate health and response to treatment.
  • Risk Stratification: Increased PSA levels can help identify patients as high-risk groups, aiding treatment planning.


  • False Positives and Negatives: Elevated PSA levels can occur from noncancerous conditions, leading to unnecessary anxiety and interventions; low PSA levels do not rule out cancer as an option.
  • Overdiagnosis and Overtreatment: PSA testing may detect slow-growing tumors that don’t pose any threat, leading to unnecessary treatments and leading to overdiagnosis and overtreatment.
  • Limited Specificity: PSA levels alone cannot distinguish between aggressive and indolent cancers, potentially leading to unnecessary invasive procedures.
  • Varying Interpretation: Normal PSA levels can fluctuate based on age or other factors, making interpretation a complex endeavor.
  • Controversial Test: PSA testing has generated heated discussions over its benefit and led to changes in screening guidelines.


  • Cancer Aggressiveness: Provides valuable insight into how aggressively prostate cancer grows over time, aiding treatment decisions.
  • Histological Information: Provides more precise analysis of cancer tissue appearance and behavior, providing accurate treatment guidance.
  • Treatment Guidance: Helps determine an individualized cancer management strategy according to cancer behavior. Prognostic Value: Anticipates future cancer development and patient outcomes.
  • Tailored Care: Gleason Score helps customize treatment plans, preventing overtreatment for less aggressive cancers. Contras: Subjectivity of interpretation may differ among pathologists, compromising consistency.
  • Sampling Bias: The Gleason Score is determined from small biopsy samples that may not accurately represent an entire tumor. Complexity: Understanding the Gleason Score requires medical expertise and can be challenging for patients.
  • Gleason Score Relies on Biopsy Tissue Only: To be effective, Gleason scores require biopsied tissue which may not always be possible or feasible for all patients. Doesn’t
  • Take into Account Other Considerations: Gleason Score should only be seen as one component in making an assessment or treatment decision that must take into account multiple elements and aspects.

How to Monitor PSA and Gleason Score After Prostate Cancer Treatment

As part of post-treatment care for prostate cancer patients, monitoring levels of Prostate-Specific Antigen (PSA) and Gleason Score is of vital importance. A baseline level for PSA will be set before beginning therapy to serve as a reference point.

Subsequent PSA tests will usually occur every 3-6 months to monitor any changes over time such as velocity or doubling time; additionally monitoring PSA nadir can give an indicator of treatment success and should also be assessed regularly to evaluate treatment’s success.

Gleason Score, which is assigned via biopsy prior to treatment, and then verified with removed tissue analysis to assess cancer severity, serves as an initial grading system. If surgery is part of your plan, removed prostate tissue is also examined in order to verify its Gleason Score and gauge cancer progression.

Follow-up biopsies may be performed after radiation or other therapies to assess tissue changes and ensure treatment success and regular consultations with your medical team are important in discussing any potential changes to your health status.

As part of your cancer care treatment and management plan, it is vitally important that you collaborate closely with an oncologist or urologist in creating an individualized monitoring plan tailored to your cancer stage, treatment type and individual risk profile. If there are sudden increases or modifications to the Gleason Score, your medical team might suggest further tests, such as imaging or additional biopsies to ascertain whether cancer recurrence has taken place.

Seeking psychosocial support through healthcare providers, support groups or therapists during this monitoring process is also helpful in managing emotional hurdles associated with post-treatment care.


PSA (Prostate-Specific Antigen) and Gleason Score are crucial to diagnosing and managing prostate cancer. PSA is produced by the prostate gland, with elevated PSA levels often signaling issues arising within or surrounding it that could indicate cancer – prompting further evaluation, these levels can also be affected by various external factors and lead to false positives and negatives in results.

The Gleason Score measures the aggressiveness of prostate cancer through microscopic examination of biopsy tissue. Pathologists assign two Gleason Grades (1-5) for the most frequent and secondary patterns of growth of cancer cells; when added together they form the Gleason Score providing insight into cancer behavior as well as informing treatment decisions.