This is a sad tale but does not surprise me at all. Research conducted looking at over 100 genetic markers accross the Gleason 3 and 4 patterns concluded that PCa risk cannot be stratified by Gleason. Gleason is nothing more than an approximation (architectural) interpretation of PCa cell structures. The study identified 5 marker clusters based on dna copy rate/replication failures as a more precise means of determining aggression and progression. You will even find members clinging onto % of G3 and G4 and G5 differentiation in biopsies and pathology reports trying to stratify risk. We are I am afraid in the dark. Those that have long survival or often do well post post RALP are nothing more than the beneficiaries of less aggressive disease. G3 can be as lethal as G5 and we have many cases of G5 living for 15+ years . Bottom line. It’s a crap shoot. Sorry for the reality check.
I agree with your comments above, ddyss. The Fresh comments above—while having a thin thread of reality embedded deeply—are largely false and worse, misleading, as conveyed.
As an illustrative example: "...PCa risk cannot be stratified by Gleason." Well, nobody uses Gleason alone. Rather, Gleason grading, PSA and clinical staging ARE used pretreatment to stratify men into risk categories. And already today in some cases, additional information, including MP-MRI findings and genomic profiling scores are resulting in more accurate risk stratification, leading to improved decision making at the pretreatment stage
Another: "Gleason is nothing more than an approximation (architectural) interpretation of PCa cell structures." Well, medical doctors who have specialized in pathology do indeed "read" the biopsy samples and match pattern architectures to give final Gleason grading, and there are indeed varying skills of pathologists (highlighting the importance of a pathology 2nd expert opinion), but in the end the readings themselves are "mostly" correct...so while it is not perfect, to say it is "merely an approximation" defies an understanding of the process.
Then, without stating this clearly, Fresh seems to have stumbled upon the bigger issue which is that clinical biopsies are merely samples of a very small percentage of the prostate, and that while there are steps (for example, MRI assisted biopsy) that can be taken to improve the odds for finding "good" samples, there is an element of statistical sampling involved.
Lastly, this is completely incorrect: "G3 can be as lethal as G5." I don't think this misstatement needs further embellishment beyond what I've already said in this post.
There was a bit of final redemption in this statement: "...we have many cases of G5 living for 15+ years." I would have said "some" instead of "many," but there are indeed cases of distinctly different virility strains in the instances of high-grade PC. But then again, nobody looks at Gleason grade only.
The post copied above is largely misleading info, and seems to be an instance of someone with a little bit of knowledge being potentially "dangerous" spreading misinformation.
Post Edited (Blackjack) : 10/28/2018 5:13:02 PM (GMT-6)