Post Operative Gleason

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

anniea
Regular Member


Date Joined May 2007
Total Posts : 234
   Posted 5/22/2008 10:16 AM (GMT -6)   
Hi Everyone!!! Hope you are all doing well.
 
I noticed some interesting posts on Gleason scores and was wondering about post-op scores. Prior to surgery Rick was an 8 after surgery it was upgraded to 4+5= 9. If the prostate is gone and he had positive margins does this mean the remaining cells are 9? We are 13 months post op and is PSA is 0.6 which is still considered low, how aggressive is Gleason 9? He has had and will not have any further treatment for the cancer. Does the cancer get more aggressive as it grows or will it be a PSA doubling time of every 90 days? Why would it be staged T1-C prior to surgery and T3-a after surgery? Is this the stage of the removed prostate or the remaining cells? How do we know if the remaining cells are just in the prostate bed or if thru blood flow they have floated through out the body? If all scans are still clean will it ever show up in the bones or elsewhere? 
 
Thanks
Diana
Rick & Diana
Age 68/ 67@ Dx
6-30-06  PSA 2.54
1-22-07  PSA 4.98
1-26-07  PSA 5.09
Diag: 2-14-07 Gleason 8 Stage T1c PSA 5.09
Bone Scan 3-1-07 Clear
3-6-07 Triple Spinal Fusion (due to old back injury)
Radical retropubic surgery 4-2-07  Post surgery Gleason 9 Stage T3a Positive margins
4-29-07 PSA 0.02
6-9-07   PSA 0.02
7-6-07   PSA 0.03
8-1-07   CT Scan & Chest X-Ray   Clean
 9-26-2007 PSA 0.07
11/1/07 PSA 0.1
11/30/07 PSA 0.12
01/31/2008 PSA 0.3
03/01/2008 PSA 0.3
04/28/08 PSA 0.6


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/22/2008 10:45 AM (GMT -6)   
Diana, I can't answer all your questions, but.............

The Post Gleason scale is a re-evaluation of the prostate and any other things (lymph nodes, seminal vessels, etc) removed during surgery. A pathologist dissects the organs and scales the cancer according to what they see then, rather than what was revealed in the pre-surgery biopsy. Post- surgery scaling is much more accurate as to what the true condition was. By the way, that's one reason a lot of men choose surgery.

If margins are positive, then it can't be determined what the scaling is for them, as the scaling is done on organs not on remaining cells. They may be able to scale the extreme organ-side margin where the prostate was removed by cutting, on the organ itself. I don't know if that is practice or not. Staging changed from T1-C to T3-C after surgery because the pathologist is better able to examine the whole prostate, rather than the little snips of it that they saw with the biopsy. Any staging reported after surgery is only the organs, not on the remaining margins, etc. I don't know that there is any formula for figuring staging if the cancer moves out from the original source after removal of the prostate. As to the other questions, I really don't know, but someone should be along who may answer them.

Post Edited (James C.) : 5/22/2008 4:47:20 PM (GMT-6)


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/22/2008 11:09 AM (GMT -6)   

I am certainly no expert here, but from what I have read, seen in the Han Tables and so on......higher Gleason scores mean a higher probability of return of cancer, even if margins were deemed clean/negative.

My urologist told me a month ago that even though my PSA is considered undetectable with the measuring means used by his office, he is probably going to suggest radiation later this year....because my post-op Gleason is a 9.  Even if it was an 8, he would do likewise.

Hopefully others will have more concrete information to share.

DanMan


Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/22/2008 7:16 PM (GMT -6)   

Hi Diana,

On the Gleason:

During a biopsy a Gleason is graded on the worst sample taken.  But the sample is only a small part of the actual tumor.  After surgery the prostate is divided into sections.  A new Gleason is assigned based on the worst section sampled.  I know it's hard to describe but the Gleason during the biopsy is not necessarily the true picture.  Sometimes it's down graded, too.  But in Ricks and miy cases we were found to have a bit worse than thought. 

 

On the Stage:

Almost none are Stage 3 or 4 in clinical staging unless more tests than a biopsy and a DRE are run.  I was T1C after biopsy was positive and the DRE was negative.  Because I was positive in the seminal vessicals I was pT3b after surgery.   

There are two Types of staging.  Clinical and Pathological. 

In Clinical, Almost all who have has a negative DRE but a positive biopsy are T1C.  But if the DRE is positive then you have at least Stage 2.  Sonetimes more tests are run in possible high risk cases to see if it can be determined to be Stage 3 or 4.  But not always.

In Pathological, which can only be performed after surgical removal of the prostate, Stage T1 is not used.  The stage is now confirmed by appying ink and slicing the prostate for examination. 

Clinical
TX -- Primary tumor cannot be assessed
T0 -- No evidence of primary tumor
T1 -- Cannot detect tumor with imaging tests
T1a -- Less than 5 percent of the prostate is affected by the tumor
T1b -- More than 5 percent of the prostate is affected by the tumor
T1c -- Tumor identified by needle biopsy, PSA elevated
T2 -- Tumor confined within prostate
T2a -- Tumor affects one-half of one lobe or less
T2b -- Tumor affects more than one-half of one lobe but not both lobes
T2c -- Tumor affects both lobes
T3 -- Tumor extends through the prostate capsule
T3a -- Tumor extends beyond the prostate capsule
T3b -- Tumor invades seminal vesicle(s)
T4 -- Tumor is fixed or invades surrounding areas, such as the bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall

Pathologic
pT2 -- Tumor confined to the prostate
pT2a -- Tumor affects one-half of one lobe or less
pT2b -- Tumor affects more than one-half of one lobe but not both lobes
pT2c -- Tumor affects both lobes
pT3 -- Tumor extends beyond the prostate
pT3a -- Tumor extends beyond the prostate
pT3b -- Tumor invades seminal vesicle(s)
pT4 -- Tumor invades the bladder, rectum

 

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Post Edited (TC-LasVegas) : 5/22/2008 8:56:50 PM (GMT-6)


anniea
Regular Member


Date Joined May 2007
Total Posts : 234
   Posted 5/22/2008 11:24 PM (GMT -6)   

Hi Guys,

Thank you for your responses. Here is a question I still do not get, please forgive my ignorance. If the post op Gleason becomes a 9 based on the removed prostate is the remaining cancer cells still a 9 or can they be down graded? I guess what I don't get is so what if the Gleason is 9 on a removed prostate it can no longer do harm if its gone? At 13 months post op his PSA is still pretty low so is it possible that he no longer has what would be considered aggressive cancer? Again, please forgive my not getting this I am just trying to understand where we are at now.

 

Thanks Again

Diana 


Rick & Diana
Age 68/ 67@ Dx
6-30-06  PSA 2.54
1-22-07  PSA 4.98
1-26-07  PSA 5.09
Diag: 2-14-07 Gleason 8 Stage T1c PSA 5.09
Bone Scan 3-1-07 Clear
3-6-07 Triple Spinal Fusion (due to old back injury)
Radical retropubic surgery 4-2-07  Post surgery Gleason 9 Stage T3a Positive margins
4-29-07 PSA 0.02
6-9-07   PSA 0.02
7-6-07   PSA 0.03
8-1-07   CT Scan & Chest X-Ray   Clean
 9-26-2007 PSA 0.07
11/1/07 PSA 0.1
11/30/07 PSA 0.12
01/31/2008 PSA 0.3
03/01/2008 PSA 0.3
04/28/08 PSA 0.6


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted Yesterday 8:28 AM (GMT -6)   
Diana, I think that after surgery the Gleason Scale is no longer applicable for rating cancer and it's presence. If the GS 9 organ is removed, then the remaining cancer cells, if any, aren't rated by any definitive scaling. IF those cells do continue to grow and spread, then some other cancer rating scale may and probably does apply. Hope this doesn't confuse the issue further.
James C.

Age 60
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
5/7/08 ED- Viagra, pump, no response- Trimix .075ml continues
Post Surgery PSA's: 3mts- 0, 6mts-0


torgeir
Regular Member


Date Joined Apr 2008
Total Posts : 35
   Posted Today 7:56 AM (GMT -6)   
Diana,
Its an interesting subject regarding prostrate cancer cells that are left after removal of the prostrate and their grading. I believe with the exception of testicular cancer there are no other cancers where a simple blood test can indicate the presence of cancer cells. With low psa levels under 1 for example does this indicate just cancer cells or a detectable tumour . Prostrate cancer is known to be slow growing and a person can go many years without knowing he has this cancer, is this also true when the prostrate is removed and cancer cells remain, is it still slow growing or does it accelerate after it leaves the prostrate.
Can anyone throw any light on this ?

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted Today 10:17 AM (GMT -6)   
Gleason is used to determing the likelyhood of relapse. Once the prostate is removed a final Gleason is determined. But the scores are needed only to determine additions treatment options. If one has a 4+5 score, the grade 4 and grade 5 cells are aggressive cancer. Treatment options would include HT or Chemo. Some will include radiating the pelvic region as well.


Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/26/2008 4:18 AM (GMT -6)   
Anniea,
Here is my understanding of it. As others have explained, Gleason Grade is a method used to indicate how much prostate cells have changed from their original appearance and function. Starting with grade 1, cells which have this grade are to all intentional purposes almost the same as normal prostate cells. Grade 2 cells are structurally altered to a greater degree than grade 1, but are still basically prostate cells. Grade 3 are becoming more abnormal still. When we get to grade 4 cells, these are beginning to lose their resemblance to, and their function as prostate cells, while grade 5, having undergone even more changes, are starting to appear to be completely different to normal prostate cells in both appearance and function. While prostate cells are functioning as prostate cells they live and die within the prostate doing the job they were intended for. Once they change they begin to behave differently and the way they behave differently is linked to their Gleason grade. Grade 1 and 2 usually remain in the prostate. This is why it is possible to adopt a "watchful waiting" with these grades.........they are not likely to escape the prostate in a hurry. Grade 3, being more aggressive than the lower grades are somewhat more likely to escape the prostate, are also reasonably slow growing and especially when the volume is small can also be "watched". When we get to grade 4 and 5 these are so altered they are likely to leave the prostate and spread either locally and distantly comparatively quickly if steps are not taken to prevent this. This is why they are usually not suitable as a "watchful waiting" candidates. However tumours are usually a mix of different grade Gleason Grade cells. Gleason "score" is a rating given to the two most common grades in a sample of prostate biopsy tissue, with the greater volume of the highest grade given first. Thus if in the sample there were grade 4 and grade 3 cells (but the volume of grade 3 cells is greater than the volume of grade 4 cells then the tumour would be given a score of 3+4=7. This is an educated guesstimate at the time of biopsy to enable hopefully the correct treatment decision to be made. This may change after the removal of the prostate. Now the pathologist can see the whole prostate and he/she may find there is actually less grade 4 than the biopsy indicated but more grade 3. In this case it is likely that the Gleason score would be downgraded to a Gleason 3+3=6. On the other hand he/she may find there is a greater volume of grade 4 and less of the grade 3 than the biopsy indicated and in this case Gleason score would be upgraded to 4+4=8 (as it was in my case). An interesting observation is that grade 5 cells usually only produce PSA at 1/2 the amount of grade 4 cells which in turn produce PSA at half the rate of grade 3 cells (per cc of tissue). i.e. A tumour of 1cc of grade 3 will give a PSA reading of 4ng per ml (cc) while a tumour the same size at a grade 4 will yield 2ng/ml (cc) and a grade 5 will give a PSA reading of 1 ng/ml (cc) per cc of tumour. So long as the cancer is completely confined to the prostate when it is removed the chances of it not returning are somewhat independent of grade. If it is all gone, it is all gone. But the higher grades by the very nature of their altered DNA have a higher chance of having already escaped the prostate but like all things PCa, this is not true in all cases. There is also the chance that as they are very changed from normal prostate tissue they may not be so heavily dependent on testosterone supply for their continued existence. But this information is based on averages and nothing is written in stone. Every case of PCa is different and different things happen to each of us on this journey, so we should always remain optimistic and continue to take the battle to this scourge.
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

Post Edited (BillyMac) : 5/26/2008 7:18:56 AM (GMT-6)


DoctorAlsoPatient
New Member


Date Joined May 2008
Total Posts : 2
   Posted 5/26/2008 12:36 PM (GMT -6)   
Diana,
After prostatectomy, if there is residual tumor in the body the Gleason score does not apply to these tumor cells. The Gleason score was developed to assist the urologist in making a prognosis, based on either the biopsy results or on the final pathologic examination of the prostate after prostatectomy. Once the prostate has been removed if there are residual tumor cells somewhere in the body, then if they could be found and taken out and looked at under the microscope, they could be assigned a histologic grade based on how much or how little the tumor cells resemble normal prostate tissue. Low grade = less aggressive = well differentiated = more similar to normal prostate. High grade = more aggressive = less well differentiated = less similar to normal prostate. But this is a histologic grade (based on the appearance under the microscope), not a Gleason score. The final Gleason score is one of the tools the urologist uses, along with the pathology report itself (margins involved/ not, seminal vesicle involvement, extracapsular spread, lymph node involvement, as well as bone scan or other imaging tests, and the post RP PSA.
Preop PSA 2.8 Sept 07, then 2.9 Oct 07
Biopsy Oct 07: 6 of 12 Positive cores, gleason 3+4
DaVinci Lap Prostatectomy Dr Lee Arlington TX, 1/10/08 Gleason 4+3, margins negative, Nodes neg.
PSA April 08 0.01


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 5/26/2008 1:29 PM (GMT -6)   
The Gleason assigned to the primary cancer (provided in the biopsy alone or surgical pathology) is the Gleason that will always be used. The context may change (calling it a recurrence for example) but the Gleason won't change again.
 

New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, May 25, 2018 10:55 AM (GMT -6)
There are a total of 2,965,912 posts in 325,287 threads.
View Active Threads


Who's Online
This forum has 162990 registered members. Please welcome our newest member, LymeMomma1110.
412 Guest(s), 7 Registered Member(s) are currently online.  Details
LymeWarrior21, tarhoosier, Dimitri71, Michael_T, 142, sgirl11, tiredofallthispoop