Grade

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• Grade and Surgery
• Grading System
• Gleason SSDIs

Grade is collected in 4 data items.

See Schemas | SSDI Data | (naaccr.org) (includes general instructions for Grade) or SEER*RSA (cancer.gov) for complete coding instructions for these data items.

Grade and Surgery

• For prostate, the registrar needs to pay close attention to the type of procedure being done, not only for Grade, but also for EOD coding. Only radical prostatectomies (see Surgery of Primary Site) remove the prostate. To qualify for pathological grade, and EOD Prostate Pathological Extension, a radical prostatectomy must be performed.
• Although TURP’s, simple prostatectomies, and prostatectomy, NOS are recorded as surgical procedures in the cancer registry abstract, they do not remove the entire prostate. They remove tissue from within the prostate, but the prostate capsule remains intact. These types of procedures are routinely done to treat Benign Prostatic Hyperplasia (BPH and qualify for Clinical Grade only.

Grading System

The Gleason Score/System is used to determine the histologic grade.

Gleason’s system assigns histologic grade to predominant (primary) and lesser (secondary) pattern of tumor. The grade numbers of the two patterns are added to obtain the Gleason score, which may range from 2 to 10. A Gleason score of less than 6 is usually not indicative of prostate cancer.

Gleason SSDIs

• Gleason Patterns Clinical: This SSDI collects the primary and secondary patterns from a prostate biopsy, TURP, simple prostatectomy, or prostatectomy, NOS.
• Gleason Score Clinical: This SSDI collects the final score, which is adding the primary and secondary patterns from the Gleason Patterns Clinical.
  • The final score is then used to determine the appropriate Clinical Grade (see below).
• Gleason Patterns Pathological: This SSDI collects the primary and secondary patterns from a radical prostatectomy.
  • A radical prostatectomy must be performed to have a Gleason Patterns pathological. A “prostatectomy, NOS” is not applicable for Gleason Patterns Pathological.
  • If a radical prostatectomy is not done, then this data item is coded as X7.
  • If it’s unknown whether a radical prostatectomy was done, code to X9.
• Gleason Score Pathological: This SSDI collects the final score, which is adding the primary and secondary patterns from the Gleason Patterns Pathological.
  • The final score is then used to determine the appropriate Pathological Grade (see below).
• Gleason Tertiary Pattern: This SSDI collects the tertiary pattern (if applicable).
  • A radical prostatectomy must be performed to have a Gleason Patterns pathological. A “prostatectomy, NOS” is not applicable for Gleason Patterns Pathological.
  • If a radical prostatectomy is not done, then this data item is coded as X7.
  • If it’s unknown whether a radical prostatectomy was done, code to X9.

The Gleason Patterns/Score Pathological are directly tied to the Surgery codes. When coding your cases, make sure that your Surgery of Primary Site is in sync with how you code the Gleason data items.

• For example, if surgery of primary site is coded to none, then your Gleason Patterns/Score Pathological and Tertiary Pattern should all be coded to X7.
• If surgery of primary site indicates that a radical prostatectomy was done, the Gleason Patterns/Score Pathological and Tertiary Pattern must not be coded to X7.

Although the Gleason SSDIs are directly related to Grade, they do NOT follow the grade rules.

• For example, if the Clinical Grade is higher than the Pathological Grade, then the Clinical Grade is recorded in the Pathological Grade field. This rule does not apply to the recording of the Gleason SSDIs.
• Gleason Patterns/Score Pathological is coded independently of the Gleason Clinical SSDIs.
  • Example: Prostate biopsy shows a 5+4 pattern, score is 9.
    • Radical Prostatectomy shows a 3+4 pattern, score is 7.
    • The higher Gleason Pattern/Score from the Clinical is NOT recorded in the Gleason Pathological SSDIs. Record the values from the radical prostatectomy.
    • However, when assigning grade, both the Clinical and Pathological Grade would be based on the 5+4 pattern, score 9 from the prostate biopsy.

*If there is a Gleason pattern/score available, use 1-5. Grades A-D are used only as a last resort.

For further information on coding grade for Prostate, see the Grade Manual, Grade ID: 17.

Grade manual can be found at Schemas | SSDI Data

Updated: June 15, 2026