I have some interesting food for thought that somewhat relates to Tud's post on Gleason Scores. I am starting a new thread for this discussion because I want to see if everyone can relate to my thinking on the matter.
This is me thinking outside of the box...
It is my theory that maybe the Gleason Sum of a tumor is not as important as the highest Gleason Grade of a tumor and the size of that grade in the tumor.
Here are my hypothetical patients:All three are after Post RP pathologies that have been thoroughly examined and there is no evidence of capsular penetration...
In patient A he has a ten gram tumor that is 70% grade 3 and 30% grade 4. He would be a sum of 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 sum 4+3=7.
In patient C he has only a 3 gram tumor that is all grade 4. He is sum 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 could have even higher risk than patient C because he also has additional cancer (let's just call it a large 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...
Which of these patients do you think has the highest risk?
Which do you think has the lowest rish?
I would think that patient C will do the best here, followed by patient A, and it is patient B that has the highest risk factors...
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas
Blog : www.caringbridge.org/visit/tonycrispino
Post Edited (TC-LasVegas) : 9/15/2010 7:13:49 AM (GMT-6)