"Gleason 6 virtually never spreads to other parts of the body"

According to the title of this post, Gleason 6 PCa rarely spreads to other parts of the body. Are seminal vesicles considered other parts of the body? If someone truly had Gleason 6, does this mean once the cancer escapes the prostate, it dies? Or does it linger?

Yooper referred response to title of thread not study.

Logo +1

logoslidat said...
If a 6 can eat up your bladder , rectum and other close in organ, it needs to be called a cancer. Change a name just so people don't get freaked over the C word. The dumbing down of society is getting scary. What will we do when the type of arguments folks on Judge Judy present become accepted. An exaggeration for sure, yet…. Orwell maybe 100 years off and it is 2084 that we need to be concerned with. War is peace, right is wrong, cancer is not cancer, evil is a sickness that can be cured with meds.

The Gleason score is only part of the risk stratification story. The other parts include at least PSA and stage (D'Amico), and may include # of positive cores and % involvement (NCCN), or age on top of that (UCSF-CAPRA).

According to the NCCN risk stratification scheme, if there is evidence that a tumor has occupied more than half of one lobe or both lobes, it is Stage T2b or T2c, respectively, and the cancer is classified as "Intermediate Risk," regardless of Gleason score. If the cancer has caused a bulge in the prostate capsule, it is staged T3a, and the cancer is classified as "High Risk," regardless of Gleason score. If it has invaded the seminal vesicles, it is stage T3b, it is classified as "Very High Risk," regardless of Gleason score.

Only Low Risk disease that by definition has none of these invasive features is eligible for Active Surveillance. So is some non-invasive tissue that evinces some mild dysplasia (as many healthy tissues do as we age) and causes low levels of PSA leakage really a cancer (i.e., Gleason 6 in the setting of Low Risk disease)? If so, what definition of the word "cancer" are you using, and when would you call a lesion "pre-cancerous?" It's not about twisting definitions of words, it's about using precise definitions of words.

- Allen

Post Edited (Tall Allen) : 8/5/2013 12:53:03 AM (GMT-6)

njs +1

Tall Allen said...

None of the doctors who are arguing for revised labeling are doing so for intermediate or higher risk cancers

To my knowledge none of them are actually auguring for it, but the idea of unqualified relabeling all GS6 lesions has at least been floated by doctors I highly respect: jco.ascopubs.org/content/30/35/4294

After giving arguments for and against relabeling, what they propose is reasonable i.e. Retaining the Word Cancer but replacing Gleason score (which is sort of like like reporting the weather forecast in degrees Kelvin) with prognostic categories I to V with the following mapping:

GS6: I
GS3+4=7: II
GS4+3=7: III
GS8: IV
GS9: V

Post Edited (njs) : 8/4/2013 3:16:14 PM (GMT-6)

Here is what the authors of the JAMA article calling for re-labeling said:

"Change cancer terminology based on companion diagnostics. Use of the term “cancer” should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated."

Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement

PDA - What I hear you saying, and I agree with you wholeheartedly if I read you right, is let's make sure we keep the Active in Active Surveillance.

The hypothetical ignorant/denial-driven man you are worried about leading astray need not be a concern because (1) the men (and women) who show up on this board are on the whole highly intelligent and not apt to make such uninformed choices (why else would they be here if not to become better informed?) and (2) anyone expressing such an uninformed opinion will be quickly, yet I hope, gently, relieved of any such misapprehensions. The title of this thread suggests to me that someone was questioning it and was open to a discussion of opinions.

I don't worry about the man with the Gleason 6 who comes here to read about its implications, I worry about the ones who don't. He might be convinced that Gleason 6 in the low risk setting is a pre-cancerous condition that requires Active Surveillance rather than immediate treatment. But even if it just slows him down and reduces his anxiety so that he makes a less rash treatment decision, I think it's a good thing.

- Allen

logo-
I can see that you're angry about something, but I genuinely have no idea what you're ranting about. If you care to explain and perhaps rephrase using some standard grammar, I might be able to address whatever your concerns are. Please feel free to email me so as not to clutter threads with flames.

Perhaps the mods can clean this up.

- Allen

Oh my goodness,

I have been absent for a while after suffering an industrial accident and having my IPad go on the blink. I just saw the title Forum Moderator after Tudpocks name.

Welcome Jim, I am pleased to such a grizzled veteran as yourself volunteer for the job. Your response above is a strong indicator of your ability to be a huge asset to the site.

Goodlife

Logo,

Your post is noted. That is not moving on.

Now please do as Tud requested, leave this and move on.

I was somewhat surprised during my last visit with the urologist when he said that perhaps Gleason 6 should be classified as something other than cancer. He mentioned that "cancer" is such an emotionally charged word that even many physicians are not immune to sometimes over-reacting.

This is a topic that is currently in vogue amongst some members scientific community and I was recently listening to a radio interview discussing the reclassifying of several cancers, not just Gleason 6 prostate cancer. For example, they specifically mentioned a type of breast cancer. That being said, I personally don't have strong feelings on the issue one way or another (perhaps still slightly in favor of the "cancer" definition) and usually avoid this specific topic because of the emotion it generates.

Jim- Thanks for explaining - I added back the missing part.