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While all men diagnosed with prostate cancer know their Gleason score, they probably don’t know much about the physician who devised this important pathology discovery. Dr. Donald F. Gleason, a pathologist who taught at the University of Minnesota, recently died at 88. He was the physician who devised the scoring system in the 1960s through his observations of the cellular architecture of the prostate, the gland that produces seminal fluid. The score is considered the most reliable indicator of the potential for prostate cancer to grow and spread. It represents the gold standard for prostrate cancer diagnosis and treatment options. And it is remarkable that the Gleason score remains the standard test despite millions of dollars spent on trying to develop molecular tests to replace it.
When men gather at support group meetings, as they do every week while being treated at U.S. proton centers, they not only share their treatment experience, but are inclined to announce their vital stats; that is, PSA and Gleason scores.
However, few men actually know the origin of their Gleason score, which is an important guide to the aggressiveness of their prostate cancer. The score is based on a pathologist’s microscopic examination of prostate tissue that has been chemically stained after a biopsy. Under a microscope, the cells can show in various patterns. To determine a Gleason score, a pathologist assigns a separate numerical grade to the two most predominant architectural patterns of the cancer cells. The grade depends on how far the cells deviate from normal appearance. The numbers range from 1 (the cells look nearly normal) to 5 (the cells have the most cancerous appearance). The sum of the two grades is the Gleason score. The lowest possible score is 2, which rarely occurs; the highest is 10. Scores of 2-4 are considered low grade; 5-7, intermediate grade; and 8-10, high grade.
High scores tend to suggest a more severe prognosis than lower scores because the more deranged, high-scoring cells usually grow faster than the more normal-appearing cells.
Donald Floyd Gleason was born in Spencer, Iowa. He was raised in Litchfield, Minnesota, where his father ran a hardware store and his mother was a teacher. Dr. Gleason studied at the University of Minnesota and earned all his degrees there. He spent his entire medical career in Minnesota and was affiliated with the VA Hospital. Over the years, doctors adopted the Gleason score slowly until 1987, when leading experts in urology and pathology recommended that it be used uniformly. It became even more widely applied with the surge in the number of prostate cancers detected with the introduction of the PSA blood test.
Last year, 186,000 men in the U.S. developed prostate cancer and some 28,000 died from it. Early detection is the key to successful treatment and cure.
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