Second path report

The Gleason score is based on the highest scored core only, so your score is now GS7 (=3+4). This puts you in the intermediate risk category, but on the low side of it.

You have many curative treatment options: surgery (robotic, laparoscopic or open), LDR brachy (seeds), HDR brachy (temporary implants), SBRT, IMRT/IGRT, proton, pencil-beam proton.

I hope you will interview lots of doctors before making your decision.

yes.  and remember that there is a pretty good chance that the actual pathology could be worse.  I think you always need to assume that.

Tall Allen says "the Gleason score is based on the highest scored core only." Are you sure that is correct?

What if the one core of G7 turns out to be the only place that grade 4 cells are found in the final pathology? Isn't it possible that the number of grade 4 cells are so small that he would still be a G6?

Moreover, I was told that when looking at recurrence rates of people diagnosed with G6 on biopsy, the rates include those found to have upgraded scores on final pathology.

FrackMe-

Yes it is correct. The reason is that even a small amount of higher grade cancer cells, composing as little as 5% of the tumor, is capable of spreading outside the prostate. Some pathologists even report a tertiary Gleason score, identifying higher grade cells that don't even compose that much of the tumor. It was found that a GS7 with a tertiary G5 component carries the same risk as a higher grade tumor.

The final pathology Gleason score, whether upgraded, downgraded or the same, is more accurate. But again, only the highest Gleason score determines the risk level.

- Allen

Tall Allan disregard postscript, operative word is gl score not gl grade. Am still interested on the rest of post tho. Logo

As F-8 said, should you choose surgery and the entire gland can be biopsied, in 30% of the cases, Gleason scores get bumped up again as more cancer is found.

right Fairwind.  I think it's not wise to assume you are "barely" a G7.  you are a G7 now  AT LEAST.  risk is intermediate, now, AT LEAST.

ed

 

Tall Allan,I was not aware of risk categories for post treatment recurrence? When I was first diagnosed close to 4 years ago. I was a gleason 6 3+3, later upgraded to 3+4 on reread slides from U o Washington, upgraded postop path went 4+3 +tertiary5= gl9.
When learning about the disease at local urologists office , I distinctly remember a little card diagramed with artist conceptions of differientations shades of grade 1 thru 5 of the cells.
I remember the grade 3 was classified intermediate risk and then on up to grade 5. It was my belief up to now that this was the only risk classification out there,i.e., pretreatment. As time has progressed I see that grade3 alone or gl6 combines is arguably cancer at all, but at the worst would be low risk. Do you know what I mean about the " grade differentiation cards that used to be out there. Some books actually show pics of actual slides, and would give the risk factor using those. This was specifically pretreatment risk factors. Just found it, diagram. 2nd edition walshes book 185, grade 3. I could be mistaken but my memory of the card Isaw, showed grade 3 as intermediate risk. Actually at his point in time, it matters not. Point is this was the only risk factor classification, I was aware of. With out boring you, I would add that in reading my actual path report it, in describing it in lay mans terms, re tert5. Said " Although the gland is primarily grade 3 and 4 cells, there are a few foci of grade 5. With my nuance for words and how they are strung together, I felt because it read primarily 3 and 4 not primarily 4 and 3 that the sequence of diff was 3+4+5. Then figured well it might be because that When they said primarily 3+4, they said that, because 3 came before 4 numerically. Again moot pt, it is at least a gl8 probably a 9. My noms are good up to a 9 due to , other than upgrade, the great path report, plus node disection minus arguably and controversial extensive pni. which is a whole other story. thanks for your time. Actually a response is not required, but any comments are always appreciated. Logo ps my chatter is due to an excessive amount of mynah bird seed I had for breakfast, tee hee

logoslidat said...

When learning about the disease at local urologists office , I distinctly remember a little card diagramed with artist conceptions of differientations shades of grade 1 thru 5 of the cells.
I remember the grade 3 was classified intermediate risk and then on up to grade 5. It was my belief up to now that this was the only risk classification out there,i.e., pretreatment. As time has progressed I see that grade3 alone or gl6 combines is arguably cancer at all, but at the worst would be low risk.

Tall Allen said...
it sounds like the chart you looked at showed the cell dysplasia associated with Gleason grades 1-5, not the risk stratification categories.

I agree with Allen. Furthermore, under the current (2005 ISUP Consensus) GS system grades 1 and 2 are rarely employed on biopsy and the classification criteria for grade 3 are tightened causing some of what used to be considered 3 to now be 4. See, e.g.:

pathologydiagnostics.org/userfiles/consensus%20gleason%20scoring%202005.pdf
www.jurology.com/article/S0022-5347(09)02704-9/abstract
prostate-cancer.org/gleason-grade-migration-changes-in-prostate-cancer-grade-in-the-contemporary-era/

So GS score of 3+3=6 is now the lowest risk pathology you are likely to ever see on biopsy.

As Allen also pointed out, the D'Amico risk classification scheme considers PSA and clinical stage in addition to the biopsy GS (see, e.g.: www.oncolink.org/experts/article1.cfm?c=90&id=2528) and there are other classification schemes as well see, e.g.:

urology.ucsf.edu/research/cancer/prostate-cancer-risk-assessment-and-the-ucsf-capra-score
pcribc.org/pages.php?pageid=8

Post Edited (njs) : 7/3/2013 9:03:21 PM (GMT-6)