Gleason Scale Question

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RickyD
Regular Member


Date Joined Dec 2009
Total Posts : 163
   Posted 1/6/2010 12:36 AM (GMT -6)   
The pathologist assigns a number to the two most prominent grades.  With that defintion how is it possible to have the same number as the TWO most prominent.  It seems by definition if you have THE most prominent is a gleason 3 for example then the SECOND most prominent cannot be a 3 also.  As i think about this it seems that any of the 1-5 numbers could only be used ONCE unless the only cells in the sample are ALL the same Gleason number.  Please help me understand.
Thanks


Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09: 1 of 12 cores positive with less than 5% volume
Gleason 3 + 3 = 6
Prostate Size Estimate on 12/2/09 = 28 grams

Post Edited (RickyD) : 1/6/2010 12:57:09 AM (GMT-7)


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 1/6/2010 12:50 AM (GMT -6)   
3+3 is an example of same/similar findings. The same number can be both first and second.
You have it right. All of the cells found in your biopsy samples were similar.

If a 3rd cell grade is found, that one could be a tertiary finding because it is very small compared to the most and second most finding. I've yet to see 4 different grades listed anywhere in the journals.
 Hilarem datorum diligit Deus


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/6/2010 1:46 AM (GMT -6)   
Ricky,
Swim as usual is right on the money.
Gleason "grade" is the grade given to the cells according to how far they diverge from normal......... grade 1 are practically normal while grade 5 are the most abnormal. Gleason "score" is the addition of the two most prominent grade types in a plug and therefore has a possible score of 10 in the worse case. If only one grade of cells are present then the two most prominent cells types are the same ie 2+2 or3+3 or 4+4 or 5+5. If a plug was comprised of 70% normal cells, 20% grade 3 cells and 10% grade 4 cells that particular plug would be a Gleason 3+4=7 with 30% involvement. I believe (I may be mistaken on this ) that the overall Gleason score is the score of the worst plug.
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 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


skeener
Regular Member


Date Joined Dec 2009
Total Posts : 214
   Posted 1/6/2010 6:07 AM (GMT -6)   
Bill
 
You wrote:
 
If a plug was comprised of 70% normal cells, 20% grade 3 cells and 10% grade 4 cells that particular plug would be a Gleason 3+4=7 with 30% involvement.
 
Just wondering if a plug was comprised of 70% normal cells, 10% grade 3 and 20% grade 4, would that particular plug have a Gleason of 4+3 = 7 always making a 4+3 worse than a 3+4?
 
Carl

Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 07/10.      


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/6/2010 11:03 AM (GMT -6)   
skeener...your assessment is correct. The 4+3 will behave very similar to those that have a Gleason 8 (4+4). That is the assumption that most doctors will work from when mapping out a treatment plan. The primary Gleason number is the prevailing cancer cell type.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/6/2010 5:24 PM (GMT -6)   
Yes Skeener, as LV-TX says a 4+3 is generally accepted to be a worse result and thus prognosis than a 3+4. I suppose it gets a little wooly though when there is a small amount present. Is a sample with 90% normal tissue and 6% grade 4 + 4% grade 3 (10% of the sample involved) really that much worse than 90% normal tissue with 6% grade 3 and 4% grade 4 (again 10% involvement)? The overall sum of all the plugs must come into play then and perhaps this is part of the reason pathologists views of a particular Gleason score vary.
Tony (TC-LasVegas) has just posted an excellent link which discusses this very thing.
prostatecancerinfolink.net/2010/01/06/an-update-on-gleason-grading-system-today/#more-7905

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 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm

Post Edited (BillyMac) : 1/6/2010 3:33:17 PM (GMT-7)

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