Posted 9/15/2010 12:24 AM (GMT -6)
Another great discussion,
Thank you Tud for the post.

I have some interesting food for thought that somewhat relates to this post. This is me thinking outside of the box...

I was 3+4=7 at biopsy, and I was 4+3=7 after surgery. And we have been learning that 3+3=6 is likely less dangerous and does not always require treatment unless the tumor is large or outside the prostate. OK

It is my theory that maybe the Gleason Sum system is not as important as the highest Gleason grade and the size of that grade in the tumor.

Here are my hypothetical patients:
All are after RP...
In patient A he has a ten gram tumor that is 70% grade 3 and 30% grade 4. He would be a 3+4=7.

In patient B he has the opposite. A ten gram tumor that is 70% grade 4 and 30% grade 3. He is 4+3=7.

In patient C he has only a 3 gram tumor that is all grade 4. He is 4+4=8.

Here's my trivia:
Why aren't patient's A and B also Gleason Sum of 8? Both have just as much Gleason grade 4 cells as patient C. The grade 3 cells are likely not going to be the problem. Patient B has far greater grade 4 tumor cells than both A and C combined. Yet he is still Gleason Sum of 7. If I used common sense, Patient A and C are the same risk according to tumor size, and patient B has the highest risk...In fact Patient A should have even higher risk than patient C because he also has additional cancer (let's call it a tertiary grade 3).

It is my contention that not just the way we view slides to define aggressiveness is very suspect, but also we are missing the key component of exactly how much of each grade is present.

This one has bugged me since day 1 of my journey...In 4 years I still don't have an acceptable answer...

Just a thought...

I would think that patient C will do the best here, followed by patient A, and patient B has the highest risk.

Tony

Post Edited (TC-LasVegas) : 9/14/2010 11:57:06 PM (GMT-6)

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