Just a question for discussion ...

So, I've read in many a post the notion (and I hope I'm not misstating what has been posted) that G6 does not go on / become G7, G8, etc, or at the very least it's very rare.

But if this is the case, for those of us G8, G9 or G10, did we just start out at that G8 or higher state? Or are we one of the very rare where it was G6 and then became more?

I'm just curious, nothing more.

I'm on the triple play train all the way -- just got inked yesterday (CT planning scan).

That is the general understanding I have as well: PC tends to be multi-focal--the average cancerous prostate has (I think) 5-7 tumors. Since the tumors appear to spring up independent of each other, it makes sense to consider that a G6 could appear in one location, and a G7 somewhere else. And so on.

No one knows the answer to that. Some theories are discussed here in the last section:

/pcnrv.blogspot.com/2017/11/myth-gleason-6-never-progresses.html

John T said...
I talked to Dr Mark Scholz, prostate oncologist at length about this. He and Dr Strum, a prostate oncologist and pathologist, believe that the DNA of the tumor does not change. A G6 stays a G6 and other tumors found are independent and have their own DNA.
There is some disagreement in that others believe in rare cases a G6 will mutate.

Which makes me wonder: Is there any research into developing DNA testing of PCa cells on biopsy that would take the guesswork out of pathologists' grading based on the how the cells look under the microscope?

This question pops up from time to time and the answers are always all over the map. We see diametrically opposed answers that are somehow all supported by incontrovertible research results. The answers often seem to be oddly convenient -- aligning perfectly with the biases of the poster -- which makes one suspect that the research is somehow ambivalent. But it's not, actually. The research is pretty clear. It's the question that's hard to understand and people just pick out the version of the question that gives the answer they want.

While there are a seemingly infinite number of ways to understand the question there are three main categories that stand out to me. We'll call them questions 1), 2), and 3), and for those of you who just want the answers, I'll start with those. The answers, respectively, are:

1) Yes, it happens frequently.
2) Yes, it happens sometimes, but rarely.
3) Why do you think you care?

So, what are the questions for these ultimate answers, stated in the form of a question?*

1) Defining a Gleason score as the highest individual score found in all the samples taken from however many tumors happen to be included in a single biopsy result, if a man is diagnosed with Gleason 6 disease is it possible that he will subsequently be diagnosed with a higher Gleason score at a later time?

2) With the same definition of a Gleason 6 diagnosis as above, is it possible that his disease will progress to a form that cannot be cured with currently available treatment options, probably due to distant metastases?

3) Considering the Gleason score of a single location in a single tumor, if a sample from that location shows Gleason 6 characteristics is it possible that a subsequent sample taken from the same location at a later time will show a higher Gleason score?

The first two questions address the situation a man finds himself in when he is diagnosed with Gleason 6 disease. The third question is a research topic which, while it may eventually lead to insights that lead to useful therapy options, is not of much immediate use to a man newly diagnosed.

Note that the answer to question 2) would be "no" if your urologist were psychic (exhibiting both remote sensing and precognition) and could tell you that your prostate contained no higher Gleason score cells that a non-psychic uro's biopsy might have missed, and never would develop any such cells. There is strong research evidence looking backwards from incurable disease that shows that it never came from Gleason 6 tumors but that information requires either a psychic urologist or a time machine to be of much use in decision making.

*With apologies to Douglas Adams and Alex Trebek for the mixing of metaphors.

It would make sense that cancer cells are heterogeneous and may start out as a mix of various grades living in the same colony. The more aggressive ones with more voracious appetites will grow rapidly until they consume all the resources available in their immediate surroundings.

If they are vastly outnumbered by lower grade cells which just sit back and suck up testosterone while the grade 4-5 cells are left with scraps, they may fail to thrive. But once the high grade guys break thru and push themselves to the front of the line they gobble up T like a muthah and proliferate rapidly. Then it's the low grade guys who die off and become scarce.

This coming from a guy who has perhaps programmed a few too many computer simulations.