Why such a big difference between gleason 3+3 and 4+3- please read

_{hi everyone, I know it sounds quite simplistic but I have been reading the gleason threads and saw that a gleason 3+3 is a score that probably wouldn't metastasize. My hubby was diagnosed with PSA 7.10 and gleason 4+3 a few months ago and urologist said he had a pelvic met- we are going this week to see a Dr Michael Morris at MSKCC who specializes in PCa -but I just was wondering is it that much of a difference between a 3+3 and 4+3, again that probably sounds very simplistic but what makes that one little number be the cell changer as it's just one number? I'm still learning for my hubby. Thanks, joyce}

Hi Joyce,

I'm going to disagree with celebrate life and say that it would be very difficult to glean anything useful, or correct, out of that Understanding Mr Gleason thread...especially for a newcomer. A little bit written there is correct, some is fancifully made-up to suit a narrow view, and other parts are just plain wrong.

I'll take a few minutes here to try to answer your question.

Despite the confusing numbering system, 3+3 is the lowest possible Gleason score reported today. 3+3 doesn't metasticize, and some pathologists, therefore, don't even think it should be called "cancer." It is generally, depending on other case characteristics, low-risk.

Gleason scores that add up to 7 are generally intermediate risk. 3+4 is generally a favorable intermediate risk, and 4+3 is generally an unfavorable intermediate risk. The difference is the amount of Gleason pattern 4 cells present. The more pattern 4, the more aggressive the tumor. 3+4 means less than 50% pattern 4, and 4+3 means greater than 50% pattern 4.

The pattern 3 cells are basically not a problem. The amount of pattern 4 cells tells you how big of a problem you might be facing for possible recurrence and advancement. There are men with 3+4 who choose not to pursue any aggressive treatment, if their other case characteristics are also favorable. 4+3 on the other hand is recommended to be aggressively treated in most cases.

Helpful?

My docs say to forget about the 6,7,8,9, or 10. Rather, they focus on the 3,4, and 5 and the amounts of each. They generally discount the 3 as being indolent and probably unable to live outside the prostate and probably not able to mutate into a 4 or 5. For them, the presence of a 4 or 5 means they take the gloves off and get very serious about the treatment methods. For me, I had a high PSA, all cores positive, and 9 of the cores contained Gs 4. That was enough for them to treat me as a high risk, though there were no conclusive signs of either local or distant advancement.

Officially, many guidelines differentiate between a 3+4=7 versus a 4+3=7. But what if the differences by percentage are very small. Then these two readings are essentially the same. My docs are aggressive for intermediate and high risk because they say in their experience the actual disease is often worse than the biopsy indicates. This is also born out by the fairly common Gleason upgrades when comparing surgical pathologies and clinical biopsies.

Even when it does not predominate the 4 can do as indicated in the above post, I would add.