Understanding Gleason scores

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BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/21/2008 7:51 PM (GMT -7)   
The Gleason scoring system confuses me a little at times and so far I have not been able to find much information on this aspect. What I'm getting at is, if you have type 4 cancer cells (for want of a better expression) in your prostate as revealed by biopsy (e.g. in Gleason 3+4=7) why is that different and perceived as better(?) than a Gleason 4+3=7 or 4+4=8. If type 4 are more poorly differentiated, therefore more aggressive, why does it matter how much is 4 and how much is 3? Why is, say, a tumour with a volume of 25% of the prostate 3+4=7, perceived as less aggressive and thus less liable to spread than, say a tumour of 4+3=7 or 4+4=8 occupying 10% of that same prostate. Does not the actual volume of type 4 differentiated cells come into play. What I'm getting at is, why does a large volume 3+4=7 have a better prognosis than say, a small volume 4+4=8? I would really like to understand.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 5/21/2008 8:09 PM (GMT -7)   
I'm not a doctor, but I was told that a gleason 3+4 means that the majority of the cancer cells are 3 and the minority of the cells are 4. There are plenty of Prostate cancer sites out there that will give you a more detailed description.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C 
5/15/08- 1st Post-Op PSA 0.07 Undetectable


smilingoldcoot
Regular Member


Date Joined Jan 2008
Total Posts : 338
   Posted 5/21/2008 8:15 PM (GMT -7)   
He are 2 links off my site that discuss gleason grading.  I hope they help
 
 
There are other links on the site also.
 
Wishing you better understanding.
Richard yeah tongue yeah
Retired USAF Richard & Debbie on The Shores of Toledo Bend Lake Louisiana
Biospy 1/10/08 Gleason 10, Stage T1C  8 of 12 samples positive all Less Than 5% 
U of Florida Proton Therapy Institute
5/2/2008 LUPRON & Casodex
IMRT to start 5/16/2008 for approx 4 weeks with Proton to follow for approx 4 weeks
Turn Stumbling Blocks into Steping Stones and Keep Smiling
Our Journey is on WWW.GLEASON10.COM
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/21/2008 9:25 PM (GMT -7)   
I have it bookmarked. An excellent site you have there with many valuable links. I do understand the significance of grading at biopsy regarding whether to, and what treatment to adopt, but have not quite got my head around the significance of the difference in grading (meaning 3+4 vs 4=3 vs 4+4) once the tumour has left the prostate. If there are poorly differentiated cells (4) floating around your body, is Gleason meaningful?
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 5/22/2008 12:01 AM (GMT -7)   
Here's my understanding -- someone please correct this if I am wrong:
 
If the majority of the cancer cells in a sample (more than 50%) are grade 4, the first figure is a 4.
If more than 5% of the cancer cells but less than 50% are grade 3, the second figure is a 3.
So in this case you would have a Gleason 4+3=7.
 
If the situation is reversed with the majority being 3, the Gleason is 3+4=7. This second case is not as serious as the first since most of the cancer cells are lower grade. But even so, the lesser volume of grade 4 is not enough to justify a lower Gleason.
 
If 95% or more of the cancer cells are grade 4, then the grade 4 is effectively occupying the 5% to 50% range as well as the "more than 50%" range. So in this case, you would have a Gleason 4+4=8. A greater volume of grade 4 -- therefore a higher Gleason.
 
Grades and percentages are judgment calls -- so the Gleason reported can vary slightly depending on who is examining the slides.
 
When it comes to cancer cells in the body, the actual volume of the original tumor is not a factor -- beyond the relative volumes taken account of by the Gleason score itself. The likelihood of an escape is much more closely related to Gleason grade rather than overall tumor volume. If it were otherwise, there would be some other grading system that gave greater weight to tumor volume.

Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week PSA: 0
No erections (of course!)
Experimenting with VED and Bimix
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/22/2008 7:19 AM (GMT -7)   
Here's what I posted earlier. Maybe more than your are looking for, but it really explained GS for me.

The Gleason Scale:

If your diagnostic tests and other examinations reveal a malignant tumor of the prostate, your physician may use the Gleason grading system to help describe the appearance of the cancerous prostate tissue.

In order to do this, a pathologist will look at the biopsied tissue under a microscope. He or she will examine the way that the cancerous cells look compared to normal prostate cells.

If the cancerous cells appear to resemble the normal prostate tissue very closely, they are said to be very well differentiated and are considered Gleason grade 1. This means that the tumor is not expected to be fast growing.

On the other hand, if the cells in question look fairly irregular and very different from the normal prostate cells, then they are very poorly differentiated and are assigned a Gleason grade 5.

Grades 2-4 are used for tumors that fall between grades 1 and 5, with higher numbers corresponding to faster-growing tumors.

Because prostate cancer tissue is often made up of areas that have different grades, the pathologist will closely examine the areas that make up the largest portion of the tissue.

Gleason grades are then given to the two most
commonly occurring patterns of cells.

Once the 2 scores have been assigned, a Gleason score can be determined by adding together the two Gleason grades.

The Gleason score that results will be a number
from 2 to 10. Scores on the higher end of the Gleason grading systen (7 through 10) usually indicate a more serious prognosis.

What is staging in prostate cancer?

To detect and diagnose prostate cancer and to determine the size and extent of the spread- or stage- of the disease, your doctor may perform tests that involve feeling the prostate (DRE), looking at internal parts of the body (scans), measuring the levels of substances in the blood (PSA test), and examining the samples of prostate tissue (biopsy).

Only by knowing how the cancer is growing and exactly where it is located in the body can you and your doctor choose the best treatment for you.

There are 2 systems used to stage prostate cancer:

*TNM STAGING

The most common method of staging prostate cancer is by using a system called the TNM staging system, which stands for Tumor, Node, Metastases.

*A,B,C,D Staging

In addition, the equivalent stages in the A,B,C,D ststem or Whitmore-Jewett staging system are given in Parentheses in the table.

When talking with your doctor, you will frequently hear the following terms regarding the stages of prostate cancer: localized, locally advanced, and metastatic.

Localized prostate cancer is a cancer that is contained within the prostate gland. Locally advanced prostate cancer is a cancer that has spread beyond the prostate to surrounding tissue and may also have spread to the pelvic lymph nodes. Metastatic prostate cancer is a cancer that has spread beyond the prostate and pelvic lymph nodes into other distant parts of the body, such as the bones.

TNM Staging System

T refers to the size of the primary tumor.
N describes the extent of regional lymph node involvement
M refers to the presence or absence of metastates

T STAGING (tumor size):

Stage TX, TO, T1

TX Primary tumor cannot be assessed
TO No evidence of primary tumor
T1 (A) Tumor not clinically apparent
T1a (A1) Tumor incidentally found in <5% of prostate sample
T1b (A2) Tumor incidentally found in >5% of prostate sample
T1c Tumor identified at needle biopsy performed to
investigate PSA elevation
Stage T2

T2 (B) Palpable tumor confined to prostate
T2a (B1N) Tumor involves less than half of one prostate lobe
T2b (B1) Tumor involves more than half of one lobe but not both lobes
T2c (B2) Tumor involves both prostate lobes

Stage T3

T3 (C1-tumor < 6cm) Tumor palpable and extends beyond prostate capsule
T3a (C1) Tumor extends beyond prostate capsule, either on one side (unilaterally) or both sides (bilaterally)
T3b (C1) Tumor invades seminal vesicles

Stage T4

T4 (C2-tumor > 6cm) Tumor is fixed or invades adjacent anatomy other than seminal vesicles:
bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall

N STAGING (lymph nodes):

Stage NX, NO, N1

NX Regional lymph nodes cannot be assessed
NO No regional lymph node metastasis
N1 (D1) Metastasis in regional lymph node or nodes

M STAGING (metastasis):

Stage MX, MO, M1

MX Presence of distant metastasis cannot be asessed
MO No distant metastasis
M1 (D2) Distant metastasis
M1a (D2) Metastasis to nonregional lymph nodes
M1b (D2) Metastatis to bone
M1c (D2) Metastasis to other distant sites

Detailed information can be found here:

http://cancerguide.org/basic.html

http://www.cancer.gov/cancertopics/factsheet/detection/staging


James C.

smilingoldcoot
Regular Member


Date Joined Jan 2008
Total Posts : 338
   Posted 5/22/2008 9:12 AM (GMT -7)   
Correct me if I am wrong.
 
My understanding is that once the cancer is outside the prostate the Gleason is no longer relevant.  The Gleason Score is only a diagnostic tool use to determine one's status when diagnosed.
 
Also, like so much about cancer, there can be disagreement on the Score from Pathologist to Pathologist.  Just another tool like the DRE and the PSA.  None are 100%
 
Richard yeah tongue yeah
Retired USAF Richard & Debbie on The Shores of Toledo Bend Lake Louisiana
Biospy 1/10/08 Gleason 10, Stage T1C  8 of 12 samples positive all Less Than 5% 
U of Florida Proton Therapy Institute
5/2/2008 LUPRON & Casodex
IMRT to start 5/16/2008 for approx 4 weeks with Proton to follow for approx 4 weeks
Turn Stumbling Blocks into Steping Stones and Keep Smiling
Our Journey is on WWW.GLEASON10.COM
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/22/2008 9:48 AM (GMT -7)   
Richard, your assumptions are correct. Scaling is for the organ, not the remains....as far as I know.

Post Edited (James C.) : 5/22/2008 4:46:51 PM (GMT-6)

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