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Posted 10/6/2010 6:52 AM (GMT 0)
I have a friend who's Gleason score was changed from a 6 to a 7 once he got his pathology report after surgery. My biopsy gleason is 3+3=6. I had one positive at 10%.  Another had some PIN in it. They were both in the same area. I'm wonder what the chances are that my Gleason score will increase when I get the pathology report if I choose surgery?
Posted 10/6/2010 7:54 AM (GMT 0)

I have looked into this and I think the answer is 30-40% probability of upgrade from a 6 to 7 depending on the study.

It's a bit strange, but my husbands biopsy result was exactly the same as your 3+3, 1 of 12 cores at 10%. His post surgery pathology was 3+4, organ confined and a relatively small cancer. What was particularly shocking was that there were 9 seperate areas of cancer.

We are now nervously waiting for the first post op PSA results tomorrow.

Hope this helps.

An


Posted 10/6/2010 9:39 AM (GMT 0)
A relevant question

I was upgraded from 6 to 7 (3+4)
There are a lot of us here at HW who have experienced similar upgrades, but HW folk are not a true cross-section of PCa patients so draw no conclusions from that.

This study from 2006 suggests that about half of 6's get upgraded to 7's and that uro's should take this into account when discussing treatment options:
www.ncbi.nlm.nih.gov/pubmed/16890675

This study says 39.9%:
www.springerlink.com/content/y67w48m5w883g7vm/

This says 30.9% upgraded and 12.3% downgraded, but does not seem to specify what actual scores were upgraded or downgraded, so it may include 7's going up to 8's etc and 9's going down to 8's
prostatecancerinfolink.net/2009/08/21/what-gleason-scores-are-telling-us/

I don't think a 6 ever gets downgraded to a 5!

try Googling "Gleason" + "upgraded"

Alf
Posted 10/6/2010 11:16 AM (GMT 0)
Anxiety, my husband's Gleason stayed the same (3+4) but his stage was upgraded to T3a (from T1c). I think ... don't know this for sure ... that while its not uncommon for the Gleason score to be upgraded after surgery, it appears to be a bit more common for the stage to be upgraded.

I do not remember what your stage was at biopsy ...if you were a T1c it will definitely change since this stage indicates that the PCa was found through an elevated PSA reading rather than through any clinical findings (such as a nodule on DRE, etc.). This was something I did not know when my husband had his surgery and, I must admit, I was totally freaked out when I read the surgical path report and saw the words "final stage: T3a, NxMx". Also, on the surgical path report, it showed that the Gleason 4 comprised 40% of the invasive tumor present (that's the sucker that breached the wall resulting in extraprostectic extension) which also surprised me.

Remember that if you do choose surgery for your PCa, the surgical path report will give you the clearest indication of how extensive (or local) your disease is. Radiation will not give you that information. This is not to say that surgery is your best choice - just pointing out one of the differences between the two treatments. I've included my signature with this post so that you can read my husband's stats before and after treatment.

Good luck with your decisions.
Posted 10/6/2010 11:54 AM (GMT 0)
I posted a thread on this website re how often the Gleason is upgraded after surgery/pathology. I based this on sig files and comments of members of this site, a group which I do thik is a fair representation of those with the disease.

In the study that alf notes "about half of 6's get upgraded to 7's". Many doctors think that 7's should be treated as 8's.

So you have a situation where your doctors are telling you 6, therefore Active Surveillance might be your decision.

Yet 6 is tooo often 7, 7's are often looked at and treated as 8's. And i'm not sure i'd simply watch my 8.

It is often very difficult for the PCA patient to make an informed decision under the circumstances.
Posted 10/6/2010 11:55 AM (GMT 0)
Anxiety,

  This is exactly one of the reason I went for surgery.  My personality could not handle not knowing exactly what was going on in there.  I am one of the guys who stayed a 6 after surgery and I am very grateful for that.  Everyone is different and you must make the best decision for yourself.  Good luck in your journey, and keep us posted please.

Ed

Posted 10/6/2010 1:42 PM (GMT 0)
I was just the opposite of my biopsy was 3+4=7 post surgery 3+3=6. What a sudrprise!

Cajun Jeff
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