Why Does My Husband's Gleason Score Have An Extra Number (3+4+5)?

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mariateresa
Regular Member


Date Joined Jun 2007
Total Posts : 95
   Posted 8/7/2007 10:29 PM (GMT -6)   
Hi Everyone,

It's Maria Teresa. I am so very grateful for all of you. Because of this forum, I'm able to "breathe" a little better! Thank you all for "holding my hand"!

Could you help me understand why my husband's Gleason Score has an extra number (3+4+5)?

Thank you!!!

Maria Teresa




This was the results of his biopsy: Five of the eight samples came back positive.

A. Infiltrating, poorly differentiated adenocarcinoma, Glesason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue. No perineural or capsular invasion is identified.

B. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 50-55% of the submitted tissue. Perineural invasion identified. Capsular invasion is not seen.

C. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue. No perineural or capsular invasion is identified.

D. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 60% of the submitted tissue. No perineural or capsular invasion is identified.

E. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 20% of the submitted tissue. No perineural or capsular invasion is identified.

AEG
Regular Member


Date Joined Nov 2005
Total Posts : 154
   Posted 8/8/2007 9:24 AM (GMT -6)   
Hi Maria Teresa,

I'm reading it as if they found some cells with a gleason of 5. It's very confusing from the way it's written. My suggestion would be to send the slides to another facility for a second opinion.

Best of luck to you.

A.

David123
New Member


Date Joined Aug 2007
Total Posts : 9
   Posted 8/8/2007 9:26 PM (GMT -6)   
I have talked with dozens of men and none of them had a third score. It doesn't sound right.

hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 8/8/2007 11:25 PM (GMT -6)   
The way the Gleason score works, the first number is what the majority of the cells are, and the second, what the second type of cells are.  That's why a Gleason of 3 + 4, is better than a 4 + 3, even though both add up to 7.  I haven't heard of a third score, but if it exists, someone in this forum will reply.  (I was wondering why you listed three scores!!)
PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01
5 month PSA, June 13, 2007:  0.08
Adjuvant therapy began June 26 with Zoladex injection
     Radiation to commence in late August
 


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 448
   Posted 8/9/2007 12:27 AM (GMT -6)   
Maria,
 
Found an article that talked about tertiary Gleason scores...
 
Excerpt from article:
 
"The standard prostate pathology report includes a primary and secondary Gleason grade. On some occasions, a tertiary grade is reported. In 2005 an International Consensus Conference of uro-pathologists suggested that the Gleason system for prostatic biopsy reports should be modified to account for the presence of a poorly differentiated or undifferentiated tertiary component. The modified approach would sum the most prevalent primary grade and the highest grade. Thus, in the situation with a primary grade 3 and a secondary grade 4, cancers with a tertiary grade of 5 would be classified as high grade (3+5). This proposal has not been implemented, as the existing system is well rooted in clinical practice"
 
 
Hope this helps...
 
God Bless!
 
Ray
Age 59 y/o - Last 3-4 years of annual general health checkups - PSA 5-6
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 Diagnosed as T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx,   approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks post-op incontinance... Overnite, went from 4-6 soaked pads a dayfrom prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
7/30/2007 ED has improved to point of 60% erection, penetration, climax w/o "toys", but on 50mg "Viagra" (I use $2 Caverta)
 


ldoun
New Member


Date Joined Jun 2007
Total Posts : 19
   Posted 8/9/2007 7:14 AM (GMT -6)   
My pathology reports all had the two score primary and secondary numbers. They also made a point of noting with a statement if ANY grade 5 cells were seen. The three score system seems to me to be a way of noting the presence of grade 5 cells. They also used that in the computed total.
Age 64
5'8" 145#
PSA pre-op 5.2 (12% free)
Gleason 3+4=7
Robotic RP 4/24/07 Dr. Albala, Duke
Post-op- Organ confined Gleason 7
6/18/07 PSA <0.1
10 wk: 0-1 mini pad per day
ED Cialis and VED prescribed


mariateresa
Regular Member


Date Joined Jun 2007
Total Posts : 95
   Posted 8/9/2007 5:57 PM (GMT -6)   
Thank you so much for helping me understand the Gleason rating system better. Ray, thanks for the link! I was searching all over the internet and could not find any information.

I did happen to find in the book, "Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation the following information: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

But the link to the information that Ray provided above is a much better explanation and was the answer I was searching for. Thanks again Ray!

P34
New Member


Date Joined Jun 2018
Total Posts : 9
   Posted 6/19/2018 5:05 PM (GMT -6)   
My report had a third number. I have an appointment Thursday with the urologist. If I can remember I'll get some further clarification.
Dx at 62
12/5/2013: PSA 12.5
11/17/2017: PSA 33.8
12/12/17: TRUS/BX, PSA 34, 59cc, PCA in 10/12 cores, G 1(2), G2 (3), G3 (5)
12/27/17: CT-Negative
12/28/17: Bone Scan-Negative
3/5/18: Robotic RRP, pT3bN0, G 4+3+5
4/19/2018: PSA 0.1
6/11/2018: PSA 0.2

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 6/20/2018 12:01 AM (GMT -6)   
I couldn't pull out references, but I have seen the third score from members here in the past, and only when a G5.

I would consider that very important information.
NOTE _ MY EMAIL HAS CHANGED!
Moderator - Prostate Cancer
(Not a medical professional)
DaVinci 10/09
IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 9/12-3/13, 6/14 to present
Prolia 6-mo inj 12/12 to present
Casodex started 12/14, end 3/15 after psa 30% rise
Zytiga 04-07/15 Xtandi 04/16-8/17
Taxotere 10/17-?

Gemlin
Veteran Member


Date Joined Jul 2015
Total Posts : 714
   Posted 6/20/2018 3:05 AM (GMT -6)   
When the pathologists see three patterns in a sample they should report all three grades:

Primary grade - the dominant pattern of the tumor (greater than 50%).

Secondary grade - the next-most frequent pattern (less than 50%, but at least 5%).

Tertiary grade - if there is a small component of a third (almost always a more aggressive) pattern.

When three grades are reported, the Gleason score is the "Primary grade" + the "Tertiary grade"
(3 + 4 + 5) -> 8

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10645
   Posted 6/20/2018 3:32 AM (GMT -6)   
Under the latest grading system, biopsies are not given a third number. The first number is the most prevalent pattern, but the second number is the highest grade pattern after the first number.So, for example, a tumor in a biopsy core that is 96% pattern 3, 3% pattern 4, and 1% pattern 5, is given as GS 3+5. Ideally, the pathologist should also give the percent pattern 4 or 5.

Surgery pathology is different. The higher grade pattern must be above 5% of the whole tumor to be given as the second number; if less than 5%, it is given as a tertiary grade. So, for example, a whole tumor that is 50% pattern 3, 40% pattern 4, and 10% pattern 5 is given as GS 3+5. But if it were 50% pattern 3, 46% pattern 4, and 4% pattern 5, it is given as GS 3+4 with a tertiary 5.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Brook58
Regular Member


Date Joined Sep 2017
Total Posts : 36
   Posted 6/20/2018 8:51 AM (GMT -6)   
Maria,
I have recently realized that I was in a higher gleason/risk group. I had a poor pathology report after surgery while being a G7 and my highest PSA of 5.5
My tumor turned out to be, 3 (50%), 4 (35%) and 5 (15%).
I guess I am one of those rare 3+5s. It will give me something to discuss with my Uro Onc next month.
PSA 1/2013 was 3.6, DRE normal.
PSA 8/2014 was 5.5, DRE normal.
Retropubic Prostatectomy 11/20/2014. Age 55.
Pathology from surgery:
Gleason 3+4=7, Tertiary Pattern 5 (15%)
Extraprostatic extension +
Seminal vesicles +
Positive margins +
Perineural invasion +
Lymph nodes, Negative
Tumor t3b
Adjuvant RT 2016

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 6/20/2018 9:15 AM (GMT -6)   
In situations where there is no secondary more than 5% then the tertiary (if any) is reported thus (my situation): G4+4 (+5). Mine was nearly all G4, with less than 5% G5. The G5 was not enough to be seondary so it was reported as tertiary. I was/am treated as a G9 score. G3, 4, 5 are G grades

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 6/20/2018 11:19 AM (GMT -6)   
Rogue lab tech...didn't know what to do...did something right or wrong...I would check with doctor...nobody seems to do that anymore...try it ….I didn't read all the responses to thread...from what I read...the rsponses...were correct...this from a guy with 2 foci of gl5 reported as tertiary 5
gleason 9 contained stopped psa testing jan 2015 with two consecutive psa's a year apart at 0.15
surgery 10/09 only treatment...eyes wide open...no sand...gonna live til I die...not the reverse forgive my virtues as well as my sins...

Cary1963
New Member


Date Joined Aug 2016
Total Posts : 14
   Posted 6/20/2018 3:55 PM (GMT -6)   
The article pasayten referenced contains good information about the presence of Terchiary 5 cells for G7 patients, and matches what my surgeon/MO/RO have told me.
Diagnosed: Feb 2016 at age 52
PSA: 15.1, 10/12 cores, 53g
Davinci RP: Apr 2016
T3bN0, Gleason 3+4, Tertiary 5
EPE+, SVI+, MAR-, PNI+, PIN+
May 2016 PSA 0.03
Prostvac V/F Immunotherapy Trial - Begin July 2016
PSA steady for 12 months at 0.03
Oct 2017 PSA 0.08
SRT+HT - Jan/Feb 2018, IMRT, 70 Gy, 6 Months Lupron
Lupron keeping PSA < 0.01 and T < 10

NorCol
Regular Member


Date Joined Dec 2017
Total Posts : 22
   Posted 6/20/2018 10:27 PM (GMT -6)   
Just a short comment. My report indicated 4+3 G7 and tertiary 5 less than 5 %. Further questioning found that T5 less than 5% did not impact G7.
RALP 08/08/17 Gleason 7 (4+3) with TP 5 less than 5%. Grade Group: 3 pT3b pNO/pMX PIN and PNI present. EPE focal left posterior. SVI present left. Bladder neck-neg. Margins uninvolved. Decipher: Intermediate Risk.
PSA: 04/30/15- 2.83 06/26/17- 7.24
6 week post-op - <.010 (Sep)
3 month post-op - <.010 (Nov)
6 month post-op - <.010 (Jan)
9 month post-op - <.010 (Apr)

P34
New Member


Date Joined Jun 2018
Total Posts : 9
   Posted 6/21/2018 4:21 PM (GMT -6)   
I saw my urologist today and he confirmed what Tall Allen said. He did say the tertiary number brought my score from 7 into the 8/9 arena though.
Dx at 62
12/5/2013: PSA 12.5
11/17/2017: PSA 33.8
12/12/17: TRUS/BX, PSA 34, 59cc, PCA in 10/12 cores, G 1(2), G2 (3), G3 (5)
12/27/17: CT-Negative
12/28/17: Bone Scan-Negative
3/5/18: Robotic RRP, pT3bN0, G 4+3+5
4/19/2018: PSA 0.1
6/11/2018: PSA 0.2
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