New guidelines on Gleason Grading are "Official"

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/6/2010 10:59 AM (GMT -6)   
World renowned pathologist Jon Epstein has worked with pretty much all the major pathology teams and has published new guidelines for assigning a Gleason score to our cancer. Notable there are no more Gleason 5's or lower. Grade 2 and grade 1 cells are to be considered pre-cancerous. Anyone with Gleason 5 is now a smaller volume G6

prostatecancerinfolink.net/2010/01/06/an-update-on-gleason-grading-system-today/#more-7905

Also note: In my case I was a 4+3=7. But it is probably that I am a smaller volume G8. The grade 3 cells are more controllable, but the Grade 4 cells are our biggest treatment concern. I took this position anyway when I decided on aggressive therapy so really no change in my treatment philosophy.

Please take the time to read this article from the InfoLink...


Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 1/6/2010 10:36:39 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/6/2010 11:08 AM (GMT -6)   
Tony, thanks for the good link and article. I wholly describe to Dr. Epstein's opinion and finding here. Think everyone should read this, particualry someone going through biopsies or recently dx.

Good deal.
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% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 372
   Posted 1/6/2010 11:09 AM (GMT -6)   

Thanks as always, Tony..........informative link.

Arnie in DE

 


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 1/6/2010 11:22 AM (GMT -6)   
Thanks for the info Tony. It's a little to late for me, but very useful for the newly diagnosed and future patients.
All the best to you for 2010.
 
Magaboo

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09, = 0.05; July 09, <0.04


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 285
   Posted 1/6/2010 12:41 PM (GMT -6)   
Thanks Tony, interesting reading.

I'm still confused after reading though... if my biopsy grading was done according to this guideline then I should have been 'On the basis of the updated Gleason system, organ-confined, Gleason score 6, margin-negative prostate cancer is “virtually 100 percent curable.”'. In fact the radiation oncologist blurted out after looking at the pathology report "wow, you should have been cured" and I wanted to reply "wow, you can kiss my lilly......." but thought better since this guy could zap my wiener if he wanted.

I guess there are always exceptions (esp. since the path report upgraded my gleason).

Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 35 sessions follow


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/6/2010 1:13 PM (GMT -6)   
Jake the reference to nearly 100% curable is exceptioned in the article by Mike Scott, the writer. Nearly is a reference that some simply are not. But there are other factors to consider including tumor volume and disease that has higher grade cells that were not detected in the biopsy. This would be your case. But Mike also points out that some don't need to attempt a cure. Factors indicate that the disease is not yet lethal and active surveillence is an option. I will be writing soon about that point as well as I agree with a new trend that is changing the name of AS to "Delayed Treatment". That's a whole new topic we will see discussed soon.

Tony
Prostate Cancer Forum Co-Moderator


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 285
   Posted 1/6/2010 4:36 PM (GMT -6)   
Thanks for the reply Tony. I look forward to the discussion on "Delayed Treatment" and hopefully extending the discussion to "Delayed Treatment after biochemical recurrence", a circumstance many here are grappling with. If, for example, based on my path report that 90% are gleason 6 cells, should I delay treating my biochemical recurrence. My reasoning is "no" since based on my doubling rate, my psa would become 4000 by 2018 (based on a doubling calculator projection) but perhaps it would level off instead of continuing on its current trajectory. I wish I knew the factors that warrant delayed treatment.

Thanks again,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 35 sessions follow

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