Gleason Score question

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compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 12/2/2009 10:51 AM (GMT -6)   
Howdy. I started reading the Strum book.
 
In it, he mentions the Gleason score for each positive core.
 
I thought the Gleason score consists of one pair of numbers (often found in your signatures).
 
Let's say 3 cores are positive. Does this mean there are 3 Gleason pairs?
 
Are there individual Gleason scores for each positive core and some overall Gleason score?
 
Mel
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 12/2/2009 10:57 AM (GMT -6)   

For each core, the first number is the primary description of what most of the cells in the sample look like.

The second number is the secondary description...of the second most common occurring pattern of cells.

Rarely, a third, terciary (did I spell that right?) number is also given...it gives more info, but isn't frequently used.

So, the order of the numbers is important.  A 3+4 means there is more 3 than anything else, and after the 3's there is more 4 than anything else.  Obviously, that is better than 4+3.

The book gives a image of what each Gleason number "looks like."

good?


Post Edited (Casey59) : 12/2/2009 9:02:58 AM (GMT-7)


compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 12/2/2009 11:02 AM (GMT -6)   

Casey:

 

No, not quite good. I understand the Gleason Score. What is confusing me are the signatures that people use. They might say 5 out of 12 cores positive, Gleason 3+4.

 

But isn't there a Gleason for each positive core (that answer is yes)? But is there an overall Gleason score? If not, shouldn;t the signature have 5 Gleason scores in this example?

 

Mel


PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 12/2/2009 11:18 AM (GMT -6)   
I understand your question, but ya know...I'm drawing a blank right now.  If I was home, I would pull out my own biopsy report to look at it, but I'm away on business this week.
 
But no worries, I'm confident that within 10 minutes you will get 10 other responses in this "chat room" forum...

riverbend
Regular Member


Date Joined Mar 2009
Total Posts : 39
   Posted 12/2/2009 11:40 AM (GMT -6)   
Your Gleason score will be the worst that they may find. For example say you take 12 cores and 5 are positive. Perhaps 4 of those cores may show Gleason 3+3 and just one of those cores shows Gleason 3+4. If that is the case you are a Gleason 7 (3+4).
Dx T1c in April, 2009 at 45 years old after recent PSA tests ranged from 2.93-3.25
2 of 14 cores positive at 5% and Gleason 3+3... 2 cores taken from a "protuberance" were "ASAP"
Proton radiation at LLMC May-June 2009


goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 12/2/2009 11:43 AM (GMT -6)   
Since most of the time they are punching the same tumor, the gleason for the cores will generally be the same. The final gleason score generally is a predominant Gleason type. The path may state a third Gleason found, but they will rate the overall agrresiveness of the tumor as one gleason score.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/2/2009 2:06 PM (GMT -6)   
With the Prostate being the size of a walnut, 12 core samples will mean that these are very close in proximity to each other. The worst score is the one that concerns you and the Dr's as it will spread

So for example knowing that one core is a 3+4 and all the others are 3+3 means little in ones corrective action path

In some cases a higher score is reported in the pathology as a more cancer stricken cell may be found, which was not taken during the Biopsy
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 12/2/2009 3:00 PM (GMT -6)   
Compiler, my husband had 2 out of 10 positive cores - one was a Gleason 3+3 and the other a Gleason 3+4.  The urologist said the overall Gleason score is always the highest - in your case and my husband's, Gleason 7. This is considered moderate or intermediate in terms of aggressiveness.  If you choose surgery, the path report will assign a final Gleason score which may be different than the biopsy. 
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


cocrgolfer
Regular Member


Date Joined Oct 2009
Total Posts : 171
   Posted 12/2/2009 3:04 PM (GMT -6)   
I had four + cores, one a 5, two 6's, and a (3+4) 7. In my ingnorance I figured, let's see, that averages out to a 6! Nope, they call your final score on whichever core gives the highest value.

Steve

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/2/2009 3:38 PM (GMT -6)   
Riverbend has it correct. Your clinical Gleason score is the highest of all your positive samples. So if you have four positive cores that were 3+3, 3+3, 4+3, and 3+3, your clinical Gleason is 4+3. You should base your decisions on the highest grade found. You should only use the one score, and you won't need the rest for their Gleason value's. What you may want to track, is how much of each core was positive (shown in percentages).

As Casey states, sometimes there is a tertiary score given, but unless it is in your biopsy document, you don't have one.

Tony
Prostate Cancer Forum Co-Moderator


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 12/2/2009 4:05 PM (GMT -6)   

Compiler, I had 5 out of 28 positive in July (RRP in Aug) with 2 gleason 8, 2 gleason 7 and one Gleason 6.  - Pathologist called it 4+4 = 8.  Your biopsy report seems pretty "average" to me.  I would trade you in a minute.  You'll be OK, think positive cause you have a lot of options now.  Old Sailor 

 

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