Tumor size vs Gleason?

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sickofbeingsic
Regular Member


Date Joined Sep 2011
Total Posts : 107
   Posted 10/14/2011 8:40 AM (GMT -6)   
Hello everyone,
I was wondering if anyone has knowledge of a correlation between the size of a tumor and the gleason score.

I have read many signatures that indicate initial gleason was 6 or 7 and after the final path report came in the tumor size changed after prostate removal to a gleason 8 or 9 or even a 10.

Some tumors show only about 10, 20 and 30% coverage yet they have a high gleason.

Some show a tumor that covers 75 to 90% of the prostate yet show a 6 0r less gleason.

It is confusing to say the least.

Does a large tumor (75%+ coverage) have anything to do with a change in mortality rate or required treatment?

Does a large size tumor give any indication as to how long a person has had the cancer?

Can a small size tumor (10,20,30% coverage)
breach the prostate as easily as a large size tumor?

What are the odds for return of PSA level changes after treatment of a small size tumor as opposed to a large size tumor?

What are the odds of a person biopsy gleason score changing after his prostate has been removed and a final lab path report findings?

Is it a sure thing that a person with a gleason score of 7+ and a large size tumor will not have the same odds as someone with a gleason of 7 and a small size tumor?

Does the size of tumor give any indication of the aggression of the cancer?

I have read some studies but most were conducted under odd conditions in the early 90s.

My cancer covered 75 to 80% of the prostate with a biopsy gleason of 7 and DRE did not show indications of a breach and was normal.
I wonder if that would have changed if I had removed my prostate and gotten a lab path report.
DX 4-2010 T3 G-7 8 of 12 cores 75% covered
PSA 4-2010 4.1
HT 5-2010 Lupron 4 month shot
PSA .5 6-2010
T >.3 6-2010
External Beam 5-2010
Heart attack 7-28-2010
Seed implant 10-2010
Lupron 4 month shot Sept 2010
6 Month shot Trelstar July21st PSA .1 March 2011
T 1.0 March 2011
PSa .1 June 2011
T 6.0 June 2011
July 2011 T level 8.0 started triple HT
Casodex daily, 4 month shot Lupron,

Riviere
Regular Member


Date Joined Jul 2011
Total Posts : 324
   Posted 10/14/2011 9:17 AM (GMT -6)   
Here's a study you might find of interest:

"Percent tumor volume predicts biochemical recurrence after radical prostatectomy: multi-institutional data analysis" www.ncbi.nlm.nih.gov/pubmed/21818571

Abstract said...
BACKGROUND:

To investigate the prognostic significance of percent tumor volume (PTV) in relation to the surgical margin status in men with prostate cancer after radical prostatectomy (RP).
METHODS:

Clinical and pathological data from 1,567 patients treated with RP only between 1995 and 2007 at participating institutions were reviewed. PTV was determined by the sum of all visually estimated tumor foci on every section. Biochemical recurrence (BCR) was defined as 2 consecutive increases in prostate-specific antigen (PSA) > 0.2 ng/ml and various clinicopathological variables were tested for prognostication of recurrence-free survival.
RESULTS:

Serum PSA at surgery was 12.5 ± 16.8 ng/ml and pathological stage was T2 in 899 (57.4%) patients. Surgical Gleason score was 7 in 842 patients (53.7%), higher than 7 in 250 (16%) patients, and in 32% of the patients, surgical margin was positive. Mean PTV was 15.7% and demonstrated a significant positive correlation with serum PSA, all pathological variables and BCR. On multivariate analysis, preoperative PSA (p = 0.012), surgical Gleason score (p < 0.0001, HR 2.183, 95% CI 1.778-2.681), and PTV (≤5, 5.1-15, >15%; p < 0.0001, HR 1.393, 95% CI 1.183-1.641) were independently prognostic of recurrence-free survival. Pathological stage demonstrated a significant relationship with BCR but was not independently prognostic in the multivariate model.
CONCLUSION:

In men with prostate cancer, preoperative PSA, surgical Gleason score, and PTV are independent predictors of recurrence-free survival after RP.


Another study:

"Tumor volume does not predict for biochemical recurrence after radical prostatectomy in patients with surgical Gleason score 6 or less prostate cancer" www.ncbi.nlm.nih.gov/pubmed/17826492

Abstract said...
OBJECTIVES:

No consensus exists regarding the prognostic value of tumor volume (TV) in predicting biochemical recurrence (BCR) of prostate cancer, especially late in the prostate-specific antigen (PSA) era. We assessed this relationship in a large cohort of patients treated at one institution with standardized pathologic assessment from 1998 to 2005.
METHODS:

Data were collected for 1833 patients undergoing radical prostatectomy for clinically localized prostate cancer since 1998. Patients receiving neoadjuvant or adjuvant therapy or with node-positive disease were excluded. Along with the routine pathologic assessment, TV was prospectively assessed in all specimens. BCR was defined as two consecutive PSA levels of 0.2 ng/mL or one PSA level of greater than 0.2 ng/mL.
RESULTS:

Although a larger TV correlated with lower rates of biochemical relapse-free survival in patients with a surgical Gleason score of 7 (P <0.0001) and surgical Gleason score of 8 or greater (P = 0.0459), the biochemical relapse-free survival rate at 4 years for low, medium, and extensive surgical Gleason score 6 or less tumors was 95%, 96%, and 97%, respectively (P = 0.65). In a multivariate model, including TV, initial PSA, EPE, seminal vesicle invasion, and surgical Gleason score, the TV predicted for BCR (P = 0.0176).
CONCLUSIONS:

The results of this large study suggest that a large TV is an independent predictor of BCR in patients with tumors of specimen Gleason score 7 or higher. In contrast, most grade 6 tumors will be organ confined, even if of high volume, and TV will not predict for BCR in these patients.



Also, it isn't too late to have another lab review your biopsy slides for a second opinion.

Nellie
Age 59 Gleason 9
1/10 PSA 14.7
5/10 Bx: Gleason 3+4
8/4/2010 RRP: Gleason 4+5; Positive Margins, PNI
Incontinence: N/A; ED: 70%
Until 4/11, PSA <.01; 4/11: .01; 6/11: .03
ADT3 started 7/20; WPRT started 8/22

Post Edited (Riviere) : 10/14/2011 8:25:37 AM (GMT-6)


Riviere
Regular Member


Date Joined Jul 2011
Total Posts : 324
   Posted 10/14/2011 10:44 AM (GMT -6)   
This study specifically address the relation between tumor volume and Gleason grade:

"Prostate biopsy volume indices do not predict for significant Gleason upgrading" www.ncbi.nlm.nih.gov/pubmed/15803004

Abstract said...
Significant discordance exists between biopsy and matched prostatectomy grades. This study tests the hypothesis that surrogate tumor volume indices available from biopsies could yield an improved prediction of the underlying pathologic Gleason grade. Records of 124 patients who underwent radical prostatectomy were reviewed. Biopsies were characterized by primary and secondary Gleason grade, number of positive cores, and linear tumor length. Surgical specimens were characterized by primary and secondary Gleason grade, organ-confined disease, seminal vesicle invasion, and margins. Biochemical failure (BF) was defined by a postoperative prostate-specific antigen >0.05 ng/mL. There were 28 patients (24%) who experienced biochemical failure. On multivariate analysis, only the pathologic Gleason sum (P = 0.012) and the cumulative tumor length (P = 0.050) were independently associated with BF, and only the cumulative tumor length was associated with nonorgan-confined disease (P = 0.034). For patients with a cumulative tumor length >10 mm, 49% (18 of 37) had nonorgan-confined disease and 37% (13 of 35) had BF compared with 29% (25 of 87) and 19% (15 of 80), respectively, if they had cumulative tumor length < or =10 mm (P <0.034). Overall, an exact match was seen in 39% of biopsy Gleason grades, whereas 21% were downgraded by 1 or more points, and 41% were upgraded by 1 or more points. On univariate or multivariate analysis, none of the biopsy surrogate volume indices examined achieved significance or suggested a trend in predicting for a clinically meaningful grade change. Although indices of tumor volume from prostate needle biopsies independently predict for organ-confined disease and BF after prostatectomy, none predicted for a clinically significant upgrading or downgrading of biopsies. This suggests that the correlation that exists between such volume surrogates and outcomes after surgery reflect tumor volume effects only, independently of any possible association between tumor volume and Gleason grade.


Please don't spend too much energy worrying about what you might have done. Don't look back, just go forward and meet the challenges as best you can. Anyway from your results it looks like the radiation did its job.

Best wishes,
Nellie
Age 59 Gleason 9
1/10 PSA 14.7
5/10 Bx: Gleason 3+4
8/4/2010 RRP: Gleason 4+5; Positive Margins, PNI
Incontinence: N/A; ED: 70%
Until 4/11, PSA <.01; 4/11: .01; 6/11: .03
ADT3 started 7/20; WPRT started 8/22

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2309
   Posted 10/14/2011 4:44 PM (GMT -6)   
My tumor was 57 grams (i don't know how to correlate that to volume) and my tumor was 15% of prostate Gleason 8.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
DaVinci surgery 2/9/09 Gleason 4+4 EPE,
Margins, SV, clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
PSA tests every 3 months undetectable
latest at 32 months: .005

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3176
   Posted 10/14/2011 7:56 PM (GMT -6)   
can anyone interpret this gobbledegook for the layman cool ?
 
thanx,
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl
8/19/11 PSA .3, T = 487 ng/dl
10/5/11 PSA .2, T = 530 ng/dl

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3620
   Posted 10/14/2011 8:27 PM (GMT -6)   
There is no relationship between tumor size and Gleason grade except that the higher either is the worse the prognosis.
The significance of a large tumor volume is that it can more easily penetrate the capsule or involve the nerves or seminal vesicles. A large tumor volume is also indicative of a faster growing cancer regardless of the Gleason grade.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3176
   Posted 10/14/2011 9:12 PM (GMT -6)   
thanx John.  that was my understanding.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl
8/19/11 PSA .3, T = 487 ng/dl
10/5/11 PSA .2, T = 530 ng/dl

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2062
   Posted 10/15/2011 3:44 AM (GMT -6)   
For me it was the location of the tumour that was the bigger issue. In fact location is pretty important generally. A large tumour right in the middle of the gland it less likely to escape than a smaller one on the edge.
A tumour near the urethra will also be something that will casue symptoms as it is more likely to press against the urethra and interfere with peeing.

Mine was spread out along the top of the gland, thus some had got in the bladder neck, some was just below the bladder and some had slipped out the back and invaded the seminal vesicles. The SVI was a major upgrade from my biopsy, but the tumour near the bladder wouldn't have had to grow much more before it was where it would have caused problems peeing, and any tumour expanding into the bladder would have meant it would proabably also been impossible to remove it surgically without eremoving the bladder too and it would also have been difficult to treat PCa there using RT without it damaging the bladder.

The location was no doubt the reason that my PSA went up after surgery as there must have been a bit in that area that the surgeon missed, but targetting my prostate bed with the SRT looks like it has sorted it.

Alf
Age dx 48
04/09 PSA 8.6, DRE neg. Biop 2/12 pos. G=3+3
07/09 RALP at AVL Amsterdam
Cath out at 1wk Dry at night
PostOp G=3+4 Bladder neck & Left SVI -T3b. No PNI No vasc.inv. Clear margins
09/09 No pads
11/09 PSA 0.1
03/10 PSA 0.4 04/10 CT.
Summer/10 66Gy SRT
09/10 PSA<0.1
01/11 PSA<0.1
04/11 PSA<0.1
07/11 PSA<0.1
10/11 PSA<0.1
No real ED

sickofbeingsic
Regular Member


Date Joined Sep 2011
Total Posts : 107
   Posted 10/15/2011 10:36 AM (GMT -6)   
Friends,

Thank you for responding as well as the good advice.

I am a retired Goephysicist. I have anylised data for over 30 years pertaining to the subsurface world we stand on.

I utilized imaging equipment just like doctors do to visualize what we cannot see with our eyes as well as core sampling and lab data to try and draw conclusions as to any anomaly in our subsurface world.

I understand that the engineering field is not an exact science and neither is the medical field.

I see a relationship between what the doctor’s review and what I used to do to collect sufficient data.

We reported our results within reasonable professional probability and doctors do the same.

This data would not influence my situation. I am over that aspect. Whatever happens happens, I nor the doctors will have any control. Only time will tell. It is what it is.

But in the mean time since my OCD kicked in, I have been analyzing data from the signatures on this forum and other forums to try and see a correlation based on uncontrolled study. Most of the studies that I have read are under control situations with age, race, and treatment.

This is an opportunity for me to try and see a pattern if there is one with uncontrolled PCa friends.

The stories as well as the stats are what I am trying to base this on so I have been doing a lot of reading for sure.

I am trying to understand how a biopsy indicates a 10cm tumor with a gleason of 8 or nine and a tumor that covers both lobs and is 75% in volume can have a gleason of 5 or 6.

Logic would make me think that a large tumor would have a greater probability of a breach as opposed to a small tumor, however I certainly cannot prove that based on the signatures. The data is bouncing all over the place and appears everyone shows different stats with different final paths.

Thanks again for the replies and I will soon get past the OCD episode and move on to another LOL.

Art

Just

I do not have a life obviously LOL.

Rest assured that I am not dwelling not pouting about my own situation. As far as I know I am cured.

Thanks
DX 4-2010 T3 G-7 8 of 12 cores 75% covered
PSA 4-2010 4.1
HT 5-2010 Lupron 4 month shot
PSA .5 6-2010
T >.3 6-2010
External Beam 5-2010
Heart attack 7-28-2010
Seed implant 10-2010
Lupron 4 month shot Sept 2010
6 Month shot Trelstar July21st PSA .1 March 2011
T 1.0 March 2011
PSa .1 June 2011
T 6.0 June 2011
July 2011 T level 8.0 started triple HT
Casodex daily, 4 month shot Lupron,

Post Edited (sickofbeingsic) : 10/15/2011 11:33:38 AM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3620
   Posted 10/15/2011 4:18 PM (GMT -6)   
Sick,
It would be helpful to understand that all PC is not created equal. A G6 works quite differently than a G9; it's in the DNA of the cancer cells. It is difficult for a G6 to matastize even if it breaches the capsule, whereas the higher grades of more agresssive grades of PC often matastsize even when post op pathology indicate a contained tumor. This difference can be seen clearly when you look at the cure rates for conventional treatments; a G6 is usually curable 95% of the time whereas a G9 has about a 50% cure rate with the same treatment.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

sickofbeingsic
Regular Member


Date Joined Sep 2011
Total Posts : 107
   Posted 10/15/2011 5:08 PM (GMT -6)   
Thanks JohnT.
That information helps a lot.
DX 4-2010 T3 G-7 8 of 12 cores 75% covered
PSA 4-2010 4.1
HT 5-2010 Lupron 4 month shot
PSA .5 6-2010
T >.3 6-2010
External Beam 5-2010
Heart attack 7-28-2010
Seed implant 10-2010
Lupron 4 month shot Sept 2010
6 Month shot Trelstar July21st PSA .1 March 2011
T 1.0 March 2011
PSa .1 June 2011
T 6.0 June 2011
July 2011 T level 8.0 started triple HT
Casodex daily, 4 month shot Lupron,

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5797
   Posted 10/15/2011 11:30 PM (GMT -6)   
sick,
 
I follow the pattern John T. described. I am a G 4+5, 20% volume (post-op path), but with EPE, and after adjuvant RT, my PSA is on the rise at a 50 day doubling time.
 
I am in the wrong 50%.
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

sickofbeingsic
Regular Member


Date Joined Sep 2011
Total Posts : 107
   Posted 10/16/2011 8:05 AM (GMT -6)   
Thanks for the info Moderator,
I am sorry that you have this worry in your world.
I have found so far that anyone can go into a hold pattern, but I have also found that for no obvious reason some progress from nowhere, maybe this is what is happening to you.
From the data that I have collected so far it looks like the #s will change based on the posted stats compared to published studies slightly.
The stats for mortality have improved but so has the treatment.
There are far less with PCa on here in the low to mid 40s, however the remission rate seems to be far higher than I expected even with stage 3 and 4.
The margin for error so far between clinical and path is not the same as reported in various published stats. My data show about 61% of the gleason scores changed after path report.
I am almost done, I need about another week to finish, but it is looking more and more positive for all of us in many ways.
Art
DX 4-2010 T3 G-7 8 of 12 cores 75% covered
PSA 4-2010 4.1
HT 5-2010 Lupron 4 month shot
PSA .5 6-2010
T >.3 6-2010
External Beam 5-2010
Heart attack 7-28-2010
Seed implant 10-2010
Lupron 4 month shot Sept 2010
6 Month shot Trelstar July21st PSA .1 March 2011
T 1.0 March 2011
PSa .1 June 2011
T 6.0 June 2011
July 2011 T level 8.0 started triple HT
Casodex daily, 4 month shot Lupron,
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