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When deciding upon a management strategy for prostate cancer, it is important to understand that prostate cancer is a highly variable cancer with a wide range of risk. The risk and expected behavior from a given prostate cancer is identified by the pathologist and described in the form of a Gleason sum or score. This is a number between 2 and 10 assigned to the prostate cancer by the pathologist based upon the appearance of the prostate cancer cells under the microscope.
To derive the Gleason score, a pathologist examining a prostate specimen will look for the dominant pattern and assign the appropriate number to that pattern. The pathologist will then look for a secondary pattern and number that as well. These numbers are added together to produce a sum or score between 2 and 10. This score and the PSA are used to stratify men into one of four categories of risk. Each risk category is then managed a little differently. Depending upon the risk category, derived from the Gleason score, a man may be observed with active surveillance, require definitive therapy, or if in a high risk category, require multimodal therapy.