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Gleason Scoring

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Posted 9/15/2010 5:42 AM (GMT 0)
Tony, in the simplest of terms, my current rad. oncologist said that you treat based on the highest number of the Gleason score, she felt that a 3+4 and a 4+3 is still a "4" cancer cell situation. My former medical oncologist from 10 years back felt the same way.

Also, and I have brought up this point a million times, a biopsy, at best, is an estimate of what is going on. In some ways, it would almost be better that a saturation type biopsy be done as the first biopsy, less chance of missing the cancer if it is there, and more probable to see the extent, as opposed to the 6/7 to 12 cores that are typically done.

With all this back and forth on Gleason 6, upgrades to Gleason 7 after surgery, to me, unless I am missing something here, is simple to explain. When they have your entire prostate on the table, they got the whole thing to test. I still feel, that's a warranted advantage to having surgery.

Better pre-treatment tools/tests is still the answer to lessen the risk and guess work of any potential treatment.

David in SC
Posted 9/15/2010 5:51 AM (GMT 0)
David said:
"With all this back and forth on Gleason 6, upgrades to Gleason 7 after surgery, to me, unless I am missing something here, is simple to explain. When they have your entire prostate on the table, they got the whole thing to test. I still feel, that's a warranted advantage to having surgery."
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You missed my point. I fully understand how Gleason scores change before and after RP. That is not my point at all.
My surgeon said the same thing as your RO. He stated that if my cancer returns that because of the grade 4 cells it will be aggressive.

This means the Gleason Sum of prostate cancer is seriously flawed. And it is quite logically so. This time remember that all three examples I gave are post RP. Go back and look at my example three patients and tell me using common sense which patient you think should be considered the highest risk...

And which one has the least risk?

Tony

Post Edited (TC-LasVegas) : 9/15/2010 12:06:28 AM (GMT-6)

Posted 9/15/2010 6:25 AM (GMT 0)
Everyone I just moved my thoughts to a new thread...

Again, Tud, this is a great post and I hope you comment on my thoughts in the new thread...

Tony
Posted 9/15/2010 6:29 AM (GMT 0)
tony,

didnt miss your point. i would rank your patients in the exact same order as you did, the patient with the highest volume of "4" would be at the most risk based on all i have learned.

david
Posted 9/15/2010 6:43 AM (GMT 0)
That really changes the landscape.

All,
I moved my post to another thread, please post responses to it here. I don't want to hijack Tud's post...

Tony
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