Nice work, Dr Jon Epstein; move over Gleason

Dr Epstein is “unarguably one of the world’s leading prostate cancer pathologists.”

He has laid out the general principles behind a new, validated prostate cancer grading system designed and intended to replace the traditional Gleason grading system over the next few years. The Gleason grading had emerged from amongst several other methods in the mid-70s as the dominant pathologists’ methodology in both research and daily practice.

Among other benefits, the Epstein's new methodology seeks to fix part of the psychological dilemma of a 3+3 case being “diagnosed with cancer”…a slippery slope which often sets into motion an irreversible chain of events leading to unnecessary aggressive treatments, and overtreatment.

Many favor the non-cancerous “label” of IDLE tumor, or other such names in such scenarios to prevent the emotionally-based over-reaction to the term “CANCER" for low-risk cases, but Epstein’s proposal takes another approach. The Gleason scale theoretically ranges from 1+1 to 5+5…causing the inherent complication of comprehending that 3+3 is indeed the lowest risk case. Epstein (effectively) will use a 5-point scale in which the lowest risk case is a 1…not 3+3, or G-6.

Theoretically, less confusion about the need (or not) to pursue aggressive treatment.

Kudos to Epstein. Read more about it at the “New” Prostate Cancer Infolink, which also includes a link to Epstein’s own article in the AUA News. http://prostatecancerinfolink.net/2015/06/10/toward-a-new-prostate-cancer-grading-system-step-1/

A rose is a rose by any other name, I'm still advanced stage PCa.

I'm sorry, if this helps anyone else then more power to the new system!

Two phrases in particular in the Prostatecancerinfolink summary of the article caught my attention:

"… cancers that are defined as Grade 1 according to the new system have no potential whatsoever for transition to metastatic disease." (Boldface mine)

and

"However, we also recognize that this new system is going to require a complete overhaul of prognostic systems like the Kattan nomograms and the Partin tables… " (as well as other things) (Again, boldface mine)

If both of these statements are true (and I'm hardly qualified to pass judgment on them), then it would seem that, first of all, guys who are now Grade 1 in this new system are going to be entirely off the hook as far as wondering if PCa is ever going to kill them or not. Presumably, for those guys PCa would become just a lingering nuisance and not much more. Yes, it could go on to cause them some grief, but it will also perhaps fall into the category of things like arthritis or something, a problem, but not a terrifying one.

Secondly, if a "complete overhaul" of things will be needed, this of course raises concerns about just how readily the prostate medical establishment is going to be willing to make such wholesale changes.

Personally, I thought the article summary seemed a bit disingenuous (not getting into issues such as testing procedures, insurance coverage, reluctance to change, etc.), but I guess we shall see.

Sounds good. But I "guarantee" not all 1's will stay 1's and right on up the line. In the pca universe…time wounds all heals. Doesn't mean most won't die of something else with "treatment" Just my thought.

Logos, Shaba: I have seen a number of AS guys on this forum tell us they are now seeking treatment because their latest biopsy has a 3+ 4 = 7 with prior biopsies of 3 + 3 = 6. This is far from a professional opinion, just a laymen's observation. Is this a newly formed tumor or a tumor that has progressed? Again, just an observation.

Epstein has said frequently that "true" G3+3 never does anything. The issue, then, is how do you know with certainty that a particular growth is that true 3+3? The two issues, as I see it, are about the quality of the biopsy, and the quality of the pathology. A pathologist can only look at the sample he gets, after all.

This new criteria is part of the answer. The other part is better biopsies and better imaging. Going together, the overtreatment will become a thing of the past.

The "traditional" term is migration, not spreading, but increase in cell differiation. It usual y happens over time. Most man who have been diagnosed late in life have probably had the disease for at least 10years. I have been reading studying various aspects of the disease for the last 6 years. I do not keep a rolodex, notes and things like that. Pca is just one ov my varied interests. I have an excellent memory and commonsense. There are oncologists that agree with migration, there are those that do not. What happens on a forum like this is group think occurs. Anytime new members show up with knowledge and will. folks coalesce one way or the other and rewrite history{history does need to be rewritten at times btw}. I do not intend to provide detailed documentation to prove my argument …it is not an argument,but an edumacated opinion. The fact that you have never heard of the thesis, not mine , others{migration} is imo because you are new{learned most from the "latest"[.03 as recurrence is the latest"for example]the forum ,I suspect }and settled in to your situation and probably do not research that that does not affect you. Not that you should or need to. To me, common sense, if there was little knowledge about cancer generally, would tell you{generically} that a cell with a x factor of differiattion will over time become less and less so . Very poor evidence, I agree, but I am quite sure of the truth of my senses and anyone who disagrees will get no argument from me. I hope the tone is not off-putting…and if my "suspicions" are wrong…ich mach nix. I mean this is more a club of cliques than a forum. The beauty is that many are helped mostly in the camaraderie sense, some in a technical sense and some not at all. its a good gathering of people…but do not be fooled be cause of the very real weaknesses of the human being…Caveat Emptor. I stayed tired… minor editing will be applied..

Post Edited (logoslidat) : 6/12/2015 9:02:02 PM (GMT-6)

Personally I have a problem with any changes that allow people or Drs. to justify not taking any grade of PC seriously. While I am not saying that is the intent, I am saying for some that is the result. Even on this site I have seen where some seem to believe (or imply) if you are a G6 or even G7 that you are fine and have plenty of time to decide on your treatment. While I think some do it to be reassuring I think sometimes it can lead others who are learning about their PC to think they are making a mountain out of a mole hill when in fact with some more testing they may discover down the line they had the mountain the whole time. And for some to believe that it is okay for some to fall through the cracks and if they in fact ended up with having had a more aggressive form of PC even though their initial grade was lower; I say bull, see how that feeling would change if that person ended up being you or a loved one.

Just by reading this site alone I see there are plenty of people who had a G6 at diagnosis and have been upgraded and had many issues that were at the time unforeseen. Diagnosis is not perfect and many variables both known and unknown can change a low risk into a high risk. That is not to say you should panic with a G6 diagnosis (or any diagnosis for that matter), but you should absolutely understand the seriousness of your PC and educate yourself and seek more info to attempt to accurately gauge the risk of your disease and fully understand there can be limitations to fully knowing the aggressiveness of it.

I do not know the details but while researching my particular PC my girlfriend read an article where they thought PC in men 60 or 55 or younger has been found quite often to be more aggressive regardless of the G-score and the thought was that they believed it might be good to reclassify PC in younger men almost entirely because of much of this type of confusion. There is a big difference in what may lie ahead for you if you are 70+ with a G6 or G7 as compared to if you are 45, and if it is true that many more cases in younger people tend to grow more rapidly, having a false sense of security at 50 with a G6 can cause you many problems down the road.

I was lucky to get diagnosed when I did because I had 0 symptoms with a normal sized prostate. I did not even want the PSA test because I come from a background where we really do not seek out Drs. and believed in not seeking trouble by finding problems. My girlfriend comes from the opposite so she convinced me to test but I refused to do it yearly. So I waited 6 years for my second test and 1.5 years for my 3rd before I reluctantly agreed to see a urologist. As part of my excuse not to get the PSA was I had heard news reports about over diagnosing and treatment of prostate cancer. Had it not been for my GF's persistence I may very well have been diagnosed too late; after some symptoms would have appeared.

My older brother has never had a PSA test because his DR. does not believe in them. My brother is 61 and this Dr. gave him a DRE once 7 years ago and that is it. When we told him to explain my PC diagnosis to his Dr. and request a PSA (he gets blood tests every 6 months already) his Dr. refused and told him 'you will die of a heart attack long before you will die of PC, so stop worrying'. Wow!! Fortunately my brother took the time to research PC on his own and has a Urologist appt. upcoming.

And I could go on and on (I think I already have) about people I encounter who hear I have PC and react with the false information that spreads like wildfire that it is a disease that is the 'easy cancer'. 'Oh, that's the one that's easy to treat and is real slow growing; isn't it?' Everyone seems to know someone who got it at an older age and died of something else, so they hear more of these news reports about how some believe it is overly diagnosed and treated and the misinformation continues to spread.

Jim

I am ( to the extent that it becomes a negative ) a man of few words. But it seems to me that the disease itself, because it is so hard to pin down causes all these different directions in attempts to 'corner' it to exist.

I'm for a new system. But what we really need is for newer technology that will show without doubt just what a persons' prostate condition is. In its' entirety. It looks like the technology is getting there, but it needs to accelerate.

My wife just yesterday went for her annual Mammogram (sic). They did what she called a 3-D mammogram. A much more advanced than previously...Our insurance refused to cover it...but we didn't care..get it anyway....

And my fear also would be that if diagnosed as a 3+3 the insurance companies would use this as an excuse to not cover further tests or any treatment if that is what someone decided to pursue. More people falling thru the cracks....

Very interesting reading, thank you.