the ISUP 2005 gleason scoring system

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An38
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Date Joined Mar 2010
Total Posts : 1147
   Posted 8/29/2010 9:28 PM (GMT -6)   
Hello all,
 
As you know the Gleason scoring system changed in 2005 and some of the changes are summarised in the link below
 
 
What intested me was the fact that that there was significant migration away from Gleason 3 to Gleason 4 (See section 7) and therefore from gleason 6 to gleason 7 cancer. Many of the papers and the studies we quote which are pre-ISUP 2005 are not working off the same Gleason scores and therefore the results of those studies are not directly comparable to the situation post 2005 and the biopsies and RP path reports done today. We might not be comparing apples with apples and from what I read here the change is not minor.
 
So, my question is, given this change in grading methodology, how do you  you read pre-ISUP 2005 studies?
 
An
 
 
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)

Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4. Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 8/30/2010 6:36 AM (GMT -6)   
An38,
Thanks for posting this. This is important to know for those who had their pathology report before 2005.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 814
   Posted 8/30/2010 8:20 AM (GMT -6)   

I stumbled across this on the web a few months ago.  I posted about this here a couple of months ago.  The goal of this was to make it easier for a more consistant grading of Gleason scores between pathologists.  It narrowed the ability to become a Gleason 3+3=6 and made it easier to become a Gleason 3+4=7.  The only way to know if you were graded to this new standard is ask your pathologist.  I inquired to mine and was told that they did use the new standard.  Basically, if you are a Gleason 3+3=6 today then you have the least aggressive form of prostate cancer that there is.  Gleason 3+3=6 today is to some extent more like a Gleason 2+2=4 or 2+3=5 if you were graded before 2005.  This is according to Dr. Epstien at Johns Hopkins.  He was on the committee that put out this revision. 

 

So, yes it is possible that if you were graded a Gleason 3+4=7 today you might have been a Gleason 3+3=6 before 2005.  It does not mean that Gleason 7 survival is improved it means that Gleason 6 survival is improved because some Gleason 6 cases with a few adverse features have been moved to Gleason 7.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 8/30/2010 9:47 AM (GMT -6)   
This has been mentioned on a few other sites. It is known as gleason grade migration. I've seen a few reperspective studies that attempt to adjust for this, but I have no idea how. I don't think there was a stage migration in the Gleason 8 and 9, but there was definately one in the 5, 6, and 7, Gleason 5 was eliminated. You are absolutely correct in that it makes comparisons difficult. Welcome to the world of PC where everyone uses a different standard to define side affects and many studies contridict one another. You just don't see this happening in dealing with other types of cancers.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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