Gleason score progression

Not necessarily, many men are Dxed with small tumors that are G8 and these may never have been a G6 or were a G6 for only a very short period of time. Younger men are usually DXed with a higher gleason grade, so obviously these have had very little time to progress from a G6. A G6 may progress, but it usually takes many years and a large % never progress and stay a low grade G6 forever, This is supported by the fact that only 2% of G6 patients ever die of pc regardless of their age at DX. If G6's were a normal progresssion to a higher Gleason, then the death rate would be significantly higher. The vast majority of DXed patients are G6 in the current area of PC testing.
Pc is either agressive, which means it progresses and spreads very rapidly or it is non agressive which means it grows slowly and will never progress to a higher gleason.
It is believed by many that the upgrade in Gleason from a pathology after surgery is mainly due to a missampling of the initial biopsy and not because of progression.
JT

<<Younger men are usually DXed with a higher gleason grade>>


JohnT - is there medical evidence to demonstrate that? I am not doubting what you say -- just wondering whether in fact a higher percentage of men who are diagnosed at a younger age are diagnosed with higher Gleason grade tumors.

The same appears true for women with breast cancer. My rad. dr. said that often the most agressive strands of breast cancer are found in the younger women at dx.

Tdog,
Let me clearify: low risk G6 is small tumor (less than 3 cores and less than 50% core involved), PSA under 10. PSA doubling time >3 years. No nodule detected. This type of low risk PC has very little chance of killing you.
If you have a detectable nodule, a high psa, or a doubling time <3 years there is a good chance of the PC progressing into a harmful pc over a number of years. and you need treatment.
There is a subset of G6 which are varients that are very dangerous; they progress very rapidily, in 6 months, even if treated. These are the 2% that are usually fatal.
Even when G6 tumors escape the capsul they grow very slowly and are easily controlled by HT.
Basically 70% of G6 tumors will show no signs of progression; around 30% do progress, either by a rising psa or move to a G7. These are easily treated with any local cure at the same 95% rate. The ones that have escaped the capsul are controlled by HT, so there are very few fatalities.
It is important to verify that you have low risk and not just an undersampled biopsy. A color doppler Ultrasound does a good job as well as having a psa history of at least two years with at least 8 data points. This will uncover any undersampling of the original biopsy.
I didn't mean to overly simplfy this in my previous post.
Most people with G6 tumors don't have a lot to worry about. the cure rates for all treatment options are in the mid 90%; the cure rates for community hospitals vs major cancer centers are in the mid 90%. I don't think that this is a coinsidence; It's much more related to the PC's agressiveness than the treatment or skill of the doctor. This is not true of the more advanced PCs. The small 5% of G6 that aren't cured are controlled with HT. So the 2% fatality rate makes sense.
The message that I was trying to convey is tht G6 tumors have a low fatality rate because many don't progress and the ones that do are easily treatable. Not that you shouldn't treat those G6s that don't fall into a low risk catagory or ones that show signs of progression.
JT

Another problem is the difference between Gleason scores after biopsies and Gleason scores after post-op pathology.


While the more advanced scans can tell you more and more these days, it's only from examining the whole prostate under a microscope after its removal that a lab can see the complete picture, so the Catch 22 is that you have to have surgery to have certainty with the numbers.



While my biopsy said 3+3 my post op Gleason was 3+4 (and the biopsy also missed the seminal vesicle invasion) so while I still cannot know what my future may bring, I am very glad to have had the operation even if it means that I got worse numbers.




As I was aged 48 at diagnosis I had already reasoned that there were simply far too many years for that 6 to become a 7 and then an 8 anyway even if it was a slow growing tumour.



And I hate to think that had the biospsy needles been a little to one side or the other then they could have come back with a 5 when I was actually a 7, so were I to have a nasty PCa in me, then I could have found myself having a repeat biospy in 2010 only to find that it had suddenly jumped to an 8.



I think that at diagnosis all you can do is assess the risk (of things getting worse) rather than know all the answers.



Statistically you are not likely to get PCa in the first place, but once you have it you then have to ignore those statistics and move on to the next set.



Statisically we are likely to be in the 95% group where PCa is not fatal, but we are only human and I think most of us will find it impossible to ignore the possibility that we might be in the other 5%.



Once you find you are Gleason 7 you have to ignore the stats for Gleason 6 and so on.



There is a lot of information/data/stats out there and it's important to manage it all to pick the relevant stuff.



Meanwhile



Happy Christmas to all



Alfred