DIFFFERENCES IN A G6 - G7 SCORE

G1 & G2 patterns are not generally reported as cancer. G1 is the base,  so represents normal cells. If you look at any of the books, you'll see that G2 is pretty close to normal as well.

Scardino writes:

"Note: Many experts today believe that patterns 1 and 2 may not be cancer at all, so it's rare to have a Gleason sum of less than 3+3=6."

Again, if you look at the diagrams used as models, 4 & 5 don't look anything like normal cells. Once a 4 is involved, things are very different.

Therefore anything equalling at least a 7 is considered malignant?

Ok, it is clear that Casey and I vehemently disagree on G3 being cancer. I relied upon my physicians and Bostwick labs to tell me if what I had was cancer. Mine believed (and still believe) that a G3 is cancer.

I will add that Dr. Scardino's book defines malignant as "Cancerous; having the capacity to escape an organ of origin and spread to other sites." That, for me, combined with my physician's opinions, would mean that a G3 or higher represents a malignancy.

By the way, I don't collect heads, as inferred earlier. They would take valuable wall space away from my books.

  BOOGEE said... Therefore anything equalling at least a 7 is considered malignant?     No, BOOGEE,   today anything at least 3+3 or higher is called “cancer.”   What I wrote was that some leading prostate cancer specialists * are currently proposing the change to 3+3 being called something other than “cancer,” but that has not gone to fruition yet .   *NOTE:   The “prostate cancer specialists” do not include Dr Casey (snicker, snicker), but they do include some other notable names…so, 142, while I’m certain you’d like to be disagreeing with me , you are really disagreeing with them .   I’m only the informed messenger, not a prostate cancer specialist.   Go HERE for an earlier excellent posting I made last November with links provided to the quotes from multiple prostate cancer specialist on this topic…even in that thread, the words are theirs, not mine.  It's just a proposal at this time; a call for action to help curb the gross swell of overtreatment for PC taking place today.   

Thanks guys I now understand.
Any sites you can refere me to just to look at slide differences?

Thanks,

BOOGEE

 

BOOGEE said...
Thanks guys I now understand.
Any sites you can refere me to just to look at slide differences?

BOOGEE, you are welcome!

Here's a LINK to a paper with pathology photos and descriptions.  Good luck trying to meaningfully understand the differences.  Even with all my years of medical training (none), I still have trouble knowing (without reading the photo captions) what is good or bad.  I leave that to the experts.

best wishes... 

 

BOOGEE, it is, indeed, a very good article.   For those who may not have clicked on the link I provided above, the article title is “ Current Perspectives on the Gleason Grading of Prostate Cancer .” The notion of “current perspectives” is relevant, and the times appear to be ripe for acceptance of changes in the professional community.   The Gleason scoring system, which was developed before the PSA-era, has already undergone several updates over the preceding decades to make it more current and relevant.   The most recent proposals on re-naming 3+3 (and there are several different suggestions from several different prostate cancer specialists, but no consensus of terminology yet) all seek to reconcile the historical and practical significance of the term “cancer.”   Now, in the PSA_era, 3+3 is the most frequently occurring pattern combination in prostate biopsies, but the 3+3 finding (when the Gleason system was developed, it was rare), using the words of one pathologist: “…cannot be adequately described by the words ‘ tumor ’ (from the Greek word for swelling), ‘ cancer ’ (from the crab-like extension), or ‘ malignant ’ (threatening to life or tending to metastasize).” The point he is making, in case it wasn't already clear enough, is that the 3+3 finding simply doesn't fit any of those terms. The “Current Perspectives” article’s author, Dr Shah, won the inaugural “Team Science Award” from the American Association of Cancer Research for the discovery of recurrent gene fusions in prostate cancer.

Hello all,
As A newbie here, I'm not sure whether to post my Gleason question here or to start a new thread. . . but here goes:

What is the significance of a tertiary Gleason score in a path report. I had a Gleason 7 (3+4) but with tertiary 5. I'm trying to figure what the implications of that might be.

Again, my apologies if this is the wrong place to ask this question.

RH

Hi and welcome, Ivolgin.

Yes, you are correct, the best thing for you to do is to introduce yourself in a new thread. Look for the button called: "Post New Topic"

Welcome!

Casey,
The very NIH panel wrote in their conclusions:

"Conclusions
Prostate cancer screening with PSA testing has identified many men with low-risk disease. Because of the very favorable prognosis of low-risk prostate cancer, strong consideration should be given to modifying the anxiety-provoking term “cancer” for this condition.

Treatment of low-risk prostate cancer patients with radical prostatectomy or radiation therapy leads to side effects such as impotence and incontinence in a substantial number. Active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer.

More than 100,000 men a year diagnosed with prostate cancer in the United States are candidates for this approach. However, there are many unanswered questions about active surveillance strategies and prostate cancer that require further research and clarification. These include:

• Improvements in the accuracy and consistency of pathologic diagnosis of prostate cancer
• Consensus on which men are the most appropriate candidates for active surveillance
• The optimal protocol for active surveillance and the potential for individualizing the approach based on clinical and patient factors
• Optimal ways to communicate the option of active surveillance to patients
• Methods to assist patient decisionmaking
• Reasons for acceptance or rejection of active surveillance as a treatment strategy
• Short- and long-term outcomes of active surveillance.

Well-designed studies to address these questions and others raised in this statement represent an important health research priority. Qualitative, observational, and interventional research designs are needed. Due to the paucity of evidence about this important public health problem, all patients being considered for active surveillance should be offered participation in multicenter research studies that incorporate community settings and partners."

As you can see, this is far from a national consensus pending results from those proposed studies.

RalphV

I have noticed the short time I have been posting on HW that often men who have high PSA's ( above normal range) for their age, often end up with negetive biopsys, but later down the road end up eventually with having PC.

What else is out there besides active surveillance.
Our surgeon told us of a formula with age + PSA determining % of men who will have PC , and we just happen to be the 25% who has it.

Should there be more care given to the G6 as a major concern.
Perhaps biopsy's won't show cancer until it reaches a G7 but that is could be brewing so using some from of treatment such as HT or some other form of treatment may prevent it from advancing instead of using active Surveillance!

Just a thought!

BOOGEE