Too hasty to have Salvage Radiation?

I know this is slightly off topic, but it has been glanced upon above. I refer to the statement that Gleason 6 never progresses to G7. Now a G6 is actually G3 + G3. A G7 is 3 + 4 or worse 4 + 3. Does this mean that G3 cells are a different disease to G4 and by extension is G5 different to G4? Can G4 morph to G5?

I have not seen a G8 which is G3 + G5 - which sort of leads me to believe that G4 can become G5.

If G3 is different to G4, why do we not see samples that have G3, G4 and G5?

Am just curious - so if anyone can point me at some reading on this I would be interested

The basic answer is yes. Look at my signature and you will see three combinations of G scores. My docs also surmised that if I had that much G4 that I probably also had G5 working as well but it wasn't enough to show up.

Most cancer is constantly evolving (mutating) as it tries to gain new foot holds and fight off attacks by our immune system and the treatments we throw at it. Thus it will often be dynamic and virulent over time.

We have seen men that are 3+5 and 5+3 here as well as on the website Yananow. The higher G scores affect fewer men and the 4+4 is a more common G8 combination. They are all the same disease, but with variations. Apart from the different G scores there are 24 different variations of PCa that have been identified. That is why two men that have similar basic risk factors like age, G score, PSA, amount of tumor involvement can have much different treatment methods and results.


In the G scores think of the grade not the score. So the question is can a 3 become a 4 or 5? I don't know and it hasn't been proven, but I expect that it can. We know cancers evolve and mutate and would expect that it can happen. Clearly 4 and 5 can get very aggressive and spread causing problems. A client of mine had a G7 that eventually turned into small cell in his lungs and killed him. His PSA was never over 10 showing that often the most aggressive will give off little or no PSA.

Then, if the question is, can a G6 become a G7. Yes, if there is enough G4 that develops to cause the 3+4 or 4+3. This development could come because there was a small amount of 4 that grows faster than the 3, or that some of the 3 mutates into the 4. Can a 3+4 become a 4+3? Yes. It is simply a different proportion of the two grades that shows that at the second measurement there was more 4 than 3. And this progression can continue right up the scale to a Gleason score of 10 (5+5).

I think what has been observed is that G3 doesn't form distant mets because it is too similar to normal prostatic tissue to be able to live outside the prostate. I don't think it has been conclusively determined that once a 3 always a 3. Also the question is does a G5 start as a 5 or does it develop up the chain in order? Remember, every cancer cell traces its ancestory back to a healthy cell that had a bad mutation that started the development chain of mutations. Logic would tell us that the development is sequential, but some have proposed that mutation can skip ahead as well and not merely follow the sequence.

We know a lot, but there is always so much more to know.

As I scan through some of the posts here, some of the wording used may be creating confusion, and some of the finer points should probably be clarified to re-set everyone to the common baseline.

One of the commonly used medical terms in this space is "progression." If someone has a biopsy 2 years ago, and their biopsy Gleason score was 3+3, and then they had a follow-up biopsy this year and their score was 3+4, their case has indicated "progression." Think of the term "progression" as indicating that from one measurement to the next, the results got worse...but it does not explain "how."

What that term does NOT mean that some of the specific Gleason grade pattern 3 cells which were captured the first time "turned into" Gleason grade 4 cells. More likely what happened is that some grade 4 cells were present but not found the first time, or new cells with Gleason grade pattern 4 cells grew. Today, scientists do not strongly believe that the predominant means of "progression" (the "how") is the morphing of cells from one pattern to another.

Here's one of the papers which speaks to this: /www.ncbi.nlm.nih.gov/pmc/articles/PMC3775342/ from the chief epidemiologist at Harvard, or the easy-to-read MedScape article about the paper here: www.medscape.com/viewarticle/809443

I got notice of my approval by the insurance company. My first radiation will be tomorrow at 8:00am. Looking forward to seeing this through, and I do really like some of the ideas for getting through it with an easier time. Thanks everyone.