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Old Sailor
Regular Member

Date Joined Aug 2009
Total Posts : 209
   Posted 9/11/2009 6:59 PM (GMT -6)   
I was wondering why if a path report for one man is 3+3 and another 4+4 and considering that both have identical path reports (no margin involvement, no escape from prostate, no seminal vessicle involvement, no lymph node involvement etc.) and both have identical 5.0 presurgery psa scores, why is the gleason 8 so much more likely to have recurrence if the cancer is totally contained.  Seems to me like both are starting from a level playing field after surgery??
The Old Sailor 

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 9/11/2009 7:38 PM (GMT -6)   

Hello Old Sailor,

The significance of the Gleason score is that it is a measure of the aggressiveness of the cancer. Higher score equals more aggressive. The more aggressive the cancer the more likely that there is or may be metastasis. Metastasis may be too small to pick up by CT or bone scans at an early stage. I had at least one doctor tell me that in my case it was highly likely that there was micro metastasis. This was due to my high PSA value coupled to the high Gleason. If you are familiar with the Parton tables and you have your numbers you can go the Sloan Kettering site and plug in the data and see what the difference is for your case versus a hypothetical case. Case 1. CS 4+4, PSA 5.0 Case 2. Gleason Score 3+3, PSA 5.0.

Do a google search on Gleason Score and Prostate cancer and you will get far better and more detailed information than I have given here.

Best wishes for a rising tide and a fair wind.



Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
PSA 06/09 .36 or .30 depending on who did the test

Veteran Member

Date Joined Apr 2008
Total Posts : 1132
   Posted 9/11/2009 8:21 PM (GMT -6)   
Old Sailor, what are your stats.

I was gleason 7 after the biopsy and came back gleason 8 after surgery. It does make a difference. It does help to catch it early and have clean margins. There are people on this site that have gleason 6's and have lymp node involvement.
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 9/11/2009 8:32 PM (GMT -6)   
It is all about the agressiveness of the cells. The cancer cells are graded from 1 - 5 in agressivness. A gleason six is typically 3+3, a gleason 7 is almost always a 3+4 or a 4+3. Some feel that a 4+3 gleason 7 is much more dangerous than a 3+4 gleason , because the first combination is made up of more of the "4" cancer cells. My own urologist feels that way and both rad. oncologist I have spoken to so far. Walsh's book on "Surviving Prostate Cancer" explains this subject in great detail in an easy way to understand.

Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days

Regular Member

Date Joined Jan 2008
Total Posts : 338
   Posted 9/11/2009 8:38 PM (GMT -6)   
old sailor
That is one of the quirks of PCa. There seems to be few definitive answers to questions only a lot of probababilities. The comparisons you make are only things that can be noted. Micro Metastasis is not observable until if and when it manifests itself in some form elsewhere in the body.
Biopsy 1998 = Neg Bio 2000 = Neg with PIN Bio 1/10/08 Gleason 10, Stage T1C 8 of 12 samples positive all < Than 5%
Bone Scan, CTs and MRI Negative early 2008
March 2008 MD Anderson - No Surgery or Proton = No Action
Feb & Mar PET (Possilbe Lymph Node Involvement  & Prostacint Scan Negative
March 2008 U of Florida Proton Therapty Lupron & Casodek May 08 for 2 years
Completed 25 IMRT and 17 PBRT U of Florida Proton Therapy Institute 7/24/08
Latest CT June 08) showed no trace of tumor in lymph node area
7/24/2008 PSA .21, free PSA .08, Percent free PSA 38.1, testosterone 14.6
8/1/2008 2nd Lupon Shot -- 10/27/2008 PSA <.01 -- 12/9/2008 3rd Lupon Shot
12/11/08 MRI Suspicious for Metastic disease L5 & S1 -- Bone Scan 12/19/08 Indicates No Bone Mets Spinal Stenosis and Neropathy in my legs
2/06/09 PSA = < .01  -- 4/09/2009  PSA <.01 --4th Lupron shot 7/02/2009 PSA <.01 Lupron
Our Journey is on WWW.GLEASONSCORE10.COM

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