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

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.

I have talked with dozens of men and none of them had a third score. It doesn't sound right.

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"

Article: http://www.medicalnewstoday.com/articles/71565.php

Hope this helps...

God Bless!

Ray

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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)

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!

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.

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NOTE _ MY EMAIL HAS CHANGED!
Moderator - Prostate Cancer
(Not a medical professional)
DaVinci 10/09
IGRT journey (2010) -
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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
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Taxotere 10/17-?

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.

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Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 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

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

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.

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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

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.

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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