New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/19/2010 6:48 PM (GMT -6)   
Perhaps this is already been thought of, but when reporting gleason scores, particularly gleason 7, ie 3+4 OR 4+3, why can't it be made more simplified.
I know there are always two components to gleason 7, and this is called the gleason differential, thus being the percentage of grade 4 cells within the count or gleason score.
Would it not be more precise and helpful to break it down even further ie
a gleason score of 3+4=7 with a gleason differential of 40% grade 4 cells, could be denominated as gleason 7.4. This would then surely give a more accurate measurement for future decision making re treatment and prognosis.
So gleason 7 could be reported as;
10% grade 4 cells = gleason 7.1
20% " " " 7.2
30% " " " 7.3
40% " " " 7.4
50% " " " 7.5
60% " " " 7.6 [Thats me]
70% " " " 7.7
80% " " " 7.8
90% " " " 7.9
Gleason 8.

I believe most pathology reports do list the percentage of grade 4 cells within the tumor, so it is pretty easy to calculate.
Please correct me if I'm wrong, but I have always wondered why it is not done this way.
Sorry guys I obviously have too much time on my hands..........Kev

Post Edited (NotHard) : 12/20/2010 11:36:26 PM (GMT-7)


TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 12/19/2010 8:48 PM (GMT -6)   
NotHard,

I think you have an excellent idea. It would help in differentiating the degree of potential aggressiveness and subsequent treatment protocols. Unfortunately, my pathology report does not list the percentage of grade 4 cells within the tumor. I am a 3 + 4, but I don't know if that means 55% grade 3 and 45% grade 4, or 90% grade 3 and 10% grade 4. I would think these two scenarios would make a big difference in terms of disease progression, etc.

TB
Dx: in 6/2005, 49 yrs old (54 now), PSA 4.1, 2/10 cores pos, G6, T1c
bone scan: negative
daVinci RRP 8/2005, Hartford Hospital
Post-surgery upgraded G7 (3+4), pT2c, NX,MX, neg. margins, PNI present, tumor focally invades capsule wall, but not entirely through it.
PSA All <0.1 until... 7/2009 0.1, 10/2009 0.2, 1/2010 0.2, 2/2010 0.14, 4/2010 0.16, 8/2010 0.25, 9/2010 0.23, 12/2010 0.22

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/19/2010 10:22 PM (GMT -6)   
TB- Perhaps make any inquiry with your pathologist as to your percentage of grade 4 cells. I am pleased you like my idea, hopefully other members will see it and start using the system in their signatures, it just might catch on.
I certainly hope I'm not re-inventing the wheel here. Perhaps we can call it the Nothard score, because its really "Not-Hard"...................lol...................Kev
Age 52yrs [Gold Coast Qld, Australia]
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
RP 24/12/08 Dr Philip Stricker [Sydney]
Upgrade Gleason Score 7.6 [4+3=7]
Stage T2c Three small foci total volume <10%
Margin status- Focal Involvement
Nil - EPE
ED- okay with Meds.
PSA at 2 yrs, no change remains 0.03
"Everyday in Every-way I Get Better'

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 12/20/2010 7:27 PM (GMT -6)   
Now that is what I call creative thinking. I love your idea too.

peace to you
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 12/20/2010 8:53 PM (GMT -6)   
Hi NotHard,
Seems like a great idea to me, however, right now I like telling myself that I had 95% 3 and 5% 4 cells :-).
With your system I would probably get a rude awakening :-(.
Hope all is well with you and have a great holiday season.

 

Mag


 

 
Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 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; at SRT Start=0.1, Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Jul 10) <.04

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 12/20/2010 11:04 PM (GMT -6)   
How they use the Gleason system has been changed several times and it's probably time they changed it again...

There are only 3 Gleason grades used today: 3. 4 and 5. 1 and 2 are no longer considered cancer so are virtually never used..

Three is three, four is four and five is five...Does the currant system offer any advantages over a simpler three number system? It must or they would not do the 3+3=6 business....
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/21/2010 12:03 AM (GMT -6)   
Fairwind, I think you are missing my point. I am not talking about the general grading system as in grade 3,4 & 5. I am purely talking about gleason 7 and its current grading system of 3+4 and 4+3. My suggestion of a new grading system is only relevant to gleason 7, way on grading. My suggestion offers a more precise grading and I think would be helpful in differentiating the degree of potential aggressiveness and subsequent treatment protocols

Post Edited (NotHard) : 12/20/2010 11:23:45 PM (GMT-7)


knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 654
   Posted 12/21/2010 6:48 AM (GMT -6)   
OK you ( and I) turned out to be 7=4+3. I think that is about as good of precsion that the data can give. My reasoning is that under your grading proposed 7.6-7.9 is a 4+3 so your treament would consider that you have more grade 4 cells than 3's would a uro or oncologist consider a different treatment if you were a 7.7 vs 7.6 and so on? Then you have the error factor in differeniating the 3 and 4 cells which is appartently not that clear and errors are made there so you end up with a decimal point score that is based on sketchly differentaing. If there were a foolproof much more accurate way of a lab tech identifying 4 vs 3 then yes the 7.x system might be helpful. Probably if the guy sees a few 3's and a bunch of 4's he would make that notation in his report. Having amore precise final score based for guesses and subjective cell counts does not seem to me as helpful. Some day where there is a machine that can count positively identified cells then you decomal system would be great.
Ron
06-08 1st biopsy neg psa 4
10-09 psa 5.5 2nd biopsy 1/12 pos. 10%, G(4+3) age 65
12-15-09 RRP Tulane NOLA Dr Lee
Path, 1%, clr marg, no EPE, no SVI, nodes cl, G(4+3)
100% incontinent after 3 mo. PT
ED, pre-op severe, post op total
10/10 Dr Boone, Baylor recomended AUS
AUS and IPP scheduled 1/11/11
post op psa's 0.04,<0.1,<0.1,0.01@12 mo.

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/21/2010 2:15 PM (GMT -6)   
Knotreel - If you look on your pathology report you will see or should see that the pathologist has already estimated the amount of grade 4 cells within your specimen. I am not suggesting this is a more accurate way of the pathologist reaching his analysis of the percentage of cells. It simply identify s the patient as to a more definite grading, which I believe would more very helpful to oncologists etc, when further treatment is necessary.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 12/21/2010 11:03 PM (GMT -6)   
Do Gleason 7, 3+4=7 do any better than 4+3=7 ? Both patients have Gleason 4 cells detected in the biopsy...

Have the 4+3=7 guys been proven statistically to be at higher risk??

I know Gleason 7 guys prefer to be 3+4=7 but in the final analysis do they live any longer than 4+3=7 ? All other things being equal, are the two patients treated any differently?

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/22/2010 12:18 AM (GMT -6)   
There are 2 schools of thought on your question, fairwind. Some say that all Gleason 7's should be treated as Gleason 8, because of the 4 component, and some say that a 3+4 is less dangerous than a 4+3. I hold to the first view, any 4 cells are agressive and unpredicable. I thought when my 4+3 was downgraded to 3+4, I might be able to buy some years before any chance of recurrance, but it happend to me in about 9 months.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/22/2010 12:27 AM (GMT -6)   
Fairwind- Very good point, this is a very controversial subject, and I do believe you are on the money. But until this is widely excepted, I guess we will always have 3+4 and 4+3. Check out the link below, regarding "Gleason 7 A New Risk Category"


http://www.prostate-online.com/gleason7.html
New Topic Post Reply Printable Version
Forum Information
Currently it is Sunday, June 24, 2018 8:43 PM (GMT -6)
There are a total of 2,974,859 posts in 326,216 threads.
View Active Threads


Who's Online
This forum has 161310 registered members. Please welcome our newest member, ejt998.
406 Guest(s), 10 Registered Member(s) are currently online.  Details
McKinley, Kent M., Artist Mark, JNF, The Dude Abides, artvark, ChickenArise, beatUC, straydog, BOB 46