[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Lower urinary tract and male genital system](https://durgical.com/en/general-pathology/areas/urinary-male/) › Prostatic adenocarcinoma: Gleason and grade groups # Prostatic adenocarcinoma: Gleason and grade groups - Lesion Small crowded glands without basal cells infiltrate the peripheral prostate; the Gleason system turns their pattern into a grade group. Updated Nov 12, 2026 ## Key points - Peripheral zone, palpable on rectal exam as a hard nodule; often multifocal. - Diagnostic clues: loss of basal cells (p63 and high-molecular-weight keratin negative), AMACR positive, prominent nucleoli, perineural invasion, crystalloids and blue mucin. - Gleason 3 = discrete glands; 4 = fused, cribriform or poorly formed glands; 5 = no glands, sheets, single cells or comedonecrosis. - Grade groups: 1 (3+3), 2 (3+4), 3 (4+3), 4 (score 8), 5 (scores 9–10). - Bone metastases are osteoblastic and favour the axial skeleton (lumbar spine via the vertebral venous plexus). ## What it is Most prostate cancers arise in the peripheral zone, near the rectum, and are multifocal. Under the microscope the malignant glands are small, crowded and infiltrative, lined by a single layer of cells with prominent nucleoli and no basal cells; perineural invasion is common. Grading uses the Gleason patterns (3 to 5 in practice), summed for the two commonest patterns and converted into five grade groups that predict outcome. Staging uses TNM: organ-confined, extraprostatic extension, seminal vesicle invasion, invasion of adjacent organs. Spread goes to pelvic nodes and to bone, producing osteoblastic metastases. Rare tumours of the prostate include ductal and neuroendocrine carcinomas, urothelial carcinoma and sarcomas. ## Structure - Gross: firm, gritty, grey-yellow areas that are hard to see; best found by targeted biopsy. - Microscopy: small glands back to back with a single cell layer, enlarged nuclei and nucleoli, no basal layer. - Immunohistochemistry confirms the absence of basal cells and shows prostatic origin (NKX3.1, PSA) in metastases. ## Clinical notes - PSA rises with cancer but also with BPH, prostatitis and instrumentation; free PSA and PSA density refine its meaning. - Back pain in an older man with high PSA and sclerotic vertebral lesions suggests metastatic prostate cancer, with risk of cord compression. ## In the lab - PSA is used for detection and for follow-up after treatment, where a rising level signals recurrence. ## Memory aid Small, crowded, single-layered and alone: the prostate gland that lost its basal partner is the cancer. ## Test yourself Think of the answer, then tap the question to see it. ## What immunostains show the absence of basal cells in prostate cancer? p63 and high-molecular-weight cytokeratin are negative, while AMACR is positive in the tumour cells. ## Which grade group corresponds to a Gleason score of 3+4? Grade group 2. ## What type of bone metastasis is typical of prostate cancer? Osteoblastic (sclerotic) metastases, mostly in the axial skeleton. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/prostatic-adenocarcinoma-gleason-and-grade-groups/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [Prostate-specific antigen (PSA)](https://durgical.com/en/biochemistry/topics/prostate-specific-antigen/) - [Grading and staging: what TNM means](https://durgical.com/en/general-pathology/grading-and-staging-what-tnm-means/) - [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/) - [Immunohistochemistry: the principle and the markers to know](https://durgical.com/en/general-pathology/immunohistochemistry-the-principle-and-the-markers-to-know/) - [Epididymis, vas deferens, seminal glands and prostate](https://durgical.com/en/histology/epididymis-vas-deferens-seminal-glands-and-prostate/) ## Connections ## Related 5 - [Prostate cancer: pathogenesis](https://durgical.com/en/general-pathology/prostate-cancer-pathogenesis/) - [Benign prostatic hyperplasia](https://durgical.com/en/general-pathology/benign-prostatic-hyperplasia/) - [Grading and staging: what TNM means](https://durgical.com/en/general-pathology/grading-and-staging-what-tnm-means/) - [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/) - [Tumour markers: serum and tissue, and what each one is for](https://durgical.com/en/general-pathology/tumour-markers-serum-and-tissue-and-what-each-one-is-for/) ## Related conditions 3 - [Prostate cancer](https://durgical.com/en/conditions/prostate-cancer/) - [Benign prostatic hyperplasia](https://durgical.com/en/conditions/benign-prostatic-hyperplasia/) - [Malignant spinal cord compression](https://durgical.com/en/conditions/malignant-spinal-cord-compression/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Prostate Cancer](https://www.ncbi.nlm.nih.gov/books/NBK470550/) (StatPearls (NCBI Bookshelf), 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/prostatic-adenocarcinoma-gleason-and-grade-groups/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/prostatic-adenocarcinoma-gleason-and-grade-groups/